title: Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea.
abstract: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided.
  
  
  
  We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep-Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization's Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity.
  
  
  
  EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies.
  
  
  
  Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and essential surgical care. This is despite a relatively low surgical volume and limited numbers of trained surgical anaesthesia obstetric providers, and likely underservicing. The ability of surgical care to avert disease in Papua New Guinea highlights its importance to public health in LMICs.
authors.affiliation: School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia. marstokes@gmail.com.|Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia. marstokes@gmail.com.
authors.forename: Matthew A R
authors.initials: MA
authors.lastname: Stokes
authors.affiliation: School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia.|Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia.
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Guest
authors.affiliation: Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea.
authors.forename: Perista
authors.initials: P
authors.lastname: Mamadi
authors.affiliation: Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea.
authors.forename: Westin
authors.initials: W
authors.lastname: Seta
authors.affiliation: Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea.
authors.forename: Noel
authors.initials: N
authors.lastname: Yaubihi
authors.affiliation: Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea.
authors.forename: Grace
authors.initials: G
authors.lastname: Karawiga
authors.affiliation: Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea.
authors.forename: Billy
authors.initials: B
authors.lastname: Naidi
authors.affiliation: School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia. watters.david@gmail.com.|Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia. watters.david@gmail.com.
authors.forename: David A K
authors.initials: DA
authors.lastname: Watters
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003906:Developing Countries; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility; D006280:Health Workforce; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult