Acute care surgery in Rwanda: Operative epidemiology and geographic variations in access to care

Type Journal Article - Surgery
Title Acute care surgery in Rwanda: Operative epidemiology and geographic variations in access to care
Volume 158
Issue 1
Publication (Day/Month/Year) 2015
Page numbers 37-43
Background. Surgical management of emergent, life-threatening diseases is an important public health
priority. The objectives of this study were to (1) describe acute care general surgery procedures performed
at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease
presentations and referral patterns.
Methods. We performed a retrospective review of prospectively collected acute care surgery cases performed at
the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011.
Using Pearson’s v2 test and the Fisher exact test, we compared cases originating from within Kigali and
transfers from other provinces. Geospatial analyses also were used to further describe transfer patterns.
Results. During the study period, 2,758 surgical interventions were performed, of which 25.6% (707/
2,758) were general surgery operations. Of these, 45.4% (321/707) met the definition of acute care
surgery. Only about one-third---32.3% (92/285)---of patients resided within Kigali, whereas about twothirds---67.7%
(193/285)---were transferred from other provinces. Most patients transferred from other
provinces were younger than 18 years of age (40.4%; 78/193), and 83.0% (39/47) of patients older than
50 years of age originated from outside of Kigali. Specific operative indications and surgical procedures
varied substantially between patients from Kigali and patients transferred from other provinces.
Conclusion. Emergency surgical conditions remain important contributors to the global burden of
disease, particularly in low- and middle-income countries. Geographic variations exist in terms of
operative diagnoses and procedures, which implies a need for improved access to surgical care at the
district level with defined transfer mechanisms to greater-level care facilities when needed

Related studies