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[NAIROBI] Patients in Africa have a double risk of dying from surgery compared with the global average, says a study.
According to the study, low-income and middle-income countries (LMICs) require 143 million surgeries each year.
But researchers say that Africa lacks data on surgical outcomes, thus it motivated them to recruit 11,422 adult patients from 247 hospitals in 25 African countries between February and May 2016, with each country using one week to complete recruitments.

“Absence of surgical care is probably a large silent killer in Africa.”

Bruce Biccard

“The main finding of this study was that patients receiving surgery in Africa are younger than the global average, with a lower-risk profile and lower complication rates, and yet are twice as likely to die,” says the study published in The Lancet this month (3 January).

According to the study, 239 patients, forming about two per cent of the patients died after surgery, which is twice the global average of one per cent.

The study was conducted in Algeria, Benin, Burundi, Cameroon, Congo, Democratic Republic of the Congo, Egypt, Ethiopia, Gambia, Ghana, Kenya, Libya, Madagascar, Mali, Mauritius, Namibia, Niger, Nigeria, Senegal, South Africa, Tanzania, Togo, Uganda, Zambia and Zimbabwe.

Bruce Biccard, the lead author, tells SciDev.Net that although the study was conducted with the aim of finding the outcomes associated with surgery in Africa, it also identified inadequate number of patients who underwent surgeries.

“Absence of surgical care is probably a large silent killer in Africa,” says Biccard, an anaesthesiologist and an honorary associate professor at the University of Kwazulu-Natal, South Africa.

He explains that LMICs have numerous problems, which result in patients not accessing surgical care, citing poor primary healthcare systems, inadequate roads and infrastructure and vast distances to surgical centres.

African governments and policymakers need to build primary healthcare networks that can identify the surgical patient who is at risk, focus on the common complications and ensure that these are treated early, Biccard explains. Liesl Zühlke, a paediatric cardiologist and president of the Paediatric Cardiac Society of South Africa, says that the study’s findings could help policymakers to tackle the gross inequalities related to surgery, lack of access to surgical care and inadequate human resources for providing access to safe surgery.

“African health ministers … [must] adopt an integrated approach [for providing] pre- and post-surgical care,” notes Zühlke, adding that surgical outcomes could be improved if adequate healthcare workers monitor patients who have undergone surgery.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Bruce M. Biccard and others Perioperative patient outcomes in the African surgical outcomes study: a seven-day prospective observational cohort study (The Lancet, 3 January 2018)