Morbidity profile and prevalence of postoperative complications among patients after a short-term surgical mission in a district hospital in Ghana: Short-term surgical mission in a district hospital

Mawuli Kotope Gyakobo; Stephen Tetteh Engmann; Forster  Amponsah-Manu; Irene Manubea Kwansa; Temitope  Arkorful; Samuel Attuah; Frank Ewusie Brown; Sefakor Juliet Kpormegbe; Samuel Yao Mayeden; Koku  Awoonor-Williams

doi:10.28982/josam.8360

Authors

Mawuli Kotope Gyakobo University of Cape Coast https://orcid.org/0000-0003-1792-1116
Stephen Tetteh Engmann University of Cape Coast https://orcid.org/0000-0002-0690-6001
Forster Amponsah-Manu Eastern Regional Hospital, Koforidua https://orcid.org/0000-0002-8764-2254
Irene Manubea Kwansa Korle Bu Teaching Hospital https://orcid.org/0009-0002-3937-1151
Temitope Arkorful Eastern Regional Hospital, Koforidua https://orcid.org/0000-0002-6007-4883
Samuel Attuah Eastern Regional Hospital, Koforidua https://orcid.org/0009-0007-5527-7866
Frank Ewusie Brown University Health Directorate, Koforidua Technical University https://orcid.org/0009-0000-8053-4202
Sefakor Juliet Kpormegbe 7Ketu North Municipal Hospital https://orcid.org/0009-0007-1751-5659
Samuel Yao Mayeden Ghana Health Service https://orcid.org/0000-0002-5586-6261
Koku Awoonor-Williams Ghana College of Physicians and Surgeons https://orcid.org/0000-0002-1094-8212

DOI:

https://doi.org/10.28982/josam.8360

Keywords:

Short-term, surgical mission, complication, prevalence, case type, diagnosis, morbidity

Abstract

Background/Aim: In most of Africa, including Ghana, access to surgical care is limited by socioeconomic factors, infrastructural constraints, and shortages in human resources. Short-term surgical missions (STSMs) have been used to bridge this gap by providing free surgical services, especially in rural areas. This study aimed to determine the morbidity profile and prevalence of postoperative complications among patients who underwent surgery during an STSM at a municipal hospital in the Volta Region of Ghana.

Methods: This cross-sectional descriptive study involved a secondary analysis of data from 180 patients who underwent surgical procedures during an STSM at Ketu North Municipal Hospital, Volta Region, Ghana, from October 27 to November 2, 2024. The mission was conducted by a local team of 38 health professionals, including surgeons, nurses, and anesthetists. Patients’ selection was based on predetermined criteria.

Results: The mean age of the patients was 45.7 (18.7) years, with a range of 2 to 82 years. Most patients were male (54.4%). Surgical care was provided for general surgical and gynecologic conditions. Inguinal hernia was the most common diagnosis (35.0%), with right-sided hernia being the predominant type, followed by lipoma (24.4%) and goiter (15.6%). Spinal anesthesia was the most frequently used anesthetic technique (47.8%). A low complication rate of 1.0% was observed, consisting mainly of urinary retention and pruritus.

Conclusion: Short-term surgical missions can effectively address surgical needs in low-resource settings such as rural Ghana by providing safe surgical care with minimal complications. These findings underscore the importance of a well-organized mission and sustainable local partnerships to improve access to surgical care and patient outcomes.

Downloads

Download data is not yet available.

References

World Health Organization. Action Framework for Safe and Affordable Surgery in the Western Pacific Region (2021-2030). World Health Organization. 2021.

World Health Organization. Ensuring safe and affordable surgery. 2024 [cited 2024 Dec 12]. Available from: https://www.who.int/westernpacific/activities/ensuring-safe-and-affordable-surgery.

Aderinto N, Olatunji G, Kokori E, Abdulrahmon MA, Akinmeji A, Fatoye JO. Expanding surgical access in Africa through improved health insurance schemes: A review. Medicine (Baltimore). 2024;103:e37488. doi: 10.1097/MD.0000000000037488.

Mehta A, Awuah WA, Aborode AT, Ng JC, Candelario K, Vieira IMP, et al. Telesurgery’s potential role in improving surgical access in Africa. Ann Med Surg. 2022;82:104511. doi: 10.1016/j.amsu.2022.104511.

Aderinto N, Opanike J, Oladipo E, Olakanmi D, Adepoju O. Accessing neurosurgical services in Africa: efforts, challenges, and recommendation. IJS Glob Health. 2022;5:1-3. doi: 10.1097/GH9.0000000000000090.

Ministry of Health, Ghana. National Surgical, Obstetric and Anesthesia Plan (NSOAP) 2025-2029. 2024.

Jumbam DT, Amoako E, Blankson P-K, Xepoleas M, Said S, Nyavor E, et al. The state of surgery, obstetrics, trauma, and anesthesia care in Ghana: a narrative review. Glob Health Action. 2022;15:2104301. doi: 10.1080/16549716.2022.2104301.

Botman M, Hendriks TCC, Keetelaar AJ, Smit FTC, Terwee CB, Hamer M, et al. From short-term surgical missions towards sustainable partnerships. A survey among members of foreign teams. Int J Surg Open. 2021;28:63-9. doi: 10.1016/j.ijso.2020.12.006.

Ibrahim GM, Cadotte DW, Bernstein M. A Framework for the Monitoring and Evaluation of International Surgical Initiatives in Low- and Middle-Income Countries. PLOS ONE. 2015;10:1-14. doi: 10.1371/journal.pone.0120368.

Mantey EE, Doh D, Lasker JN, Alang S, Donkor P, Aldrink M. Ghanaian views of short-term medical missions: The pros, the cons, and the possibilities for improvement. Glob Health. 2021;17:115. doi: 10.1186/s12992-021-00741-0.

Nagengast ES, Munabi NCO, Xepoleas M, Auslander A, Magee WP, Chong D. The Local Mission: Improving Access to Surgical Care in Middle-Income Countries. World J Surg. 2021;45:962-9. doi: 10.1007/s00268-020-05882-8.

Padmanaban V, Johnston PF, Gyakobo M, Benneh A, Esinam A, Sifri ZC. Long-Term Follow-Up of Humanitarian Surgeries: Outcomes and Patient Satisfaction in Rural Ghana. J Surg Res. 2020;246:106-12. doi: 10.1016/j.jss.2019.08.017.

Honeyman C, Patel V, Yonis E, Fell M, Demissie Y, Eshete M, et al. Long-term outcomes associated with short-term surgical missions treating complex head and neck disfigurement in Ethiopia: A retrospective cohort study. J Plast Reconstr Aesthet Surg. 2020;73:951-8. doi: 10.1016/j.bjps.2019.12.009.

Johnston PF, Kunac A, Gyakobo M, Jalloh S, Livingston DH, Sifri ZC. Short-term surgical missions in resource-limited environments: Five years of early surgical outcomes. Am J Surg. 2019;217:7-11. doi: 10.1016/j.amjsurg.2018.05.014.

Armah P, Kicha D. Primary health care in Ghana: the structure and functions in relation to preventing neglected tropical diseases. Arch Euromedica. 2020;10:12-7. doi: 10.35630/2199-885x/2020/10/3.2.

Djedjo L, Martins M do CO, Bicho L, Andrade D, Sidiropoulou Z. Short-Term Surgical Mission in Sub-Saharan Country, Experience of a Breast-Dedicated Team: Reviewing the Past and Stepping Toward the Last Mission. JCO Glob Oncol. 2023. doi: 10.1200/go.22.00317.

Yadeta DA, Manyazewal T, Demessie DB, Kleive D. Incidence and predictors of postoperative complications in Sub-Saharan Africa: a systematic review and meta-analysis. Front Health Serv. 2024;4. doi: 10.3389/frhs.2024.1353788.

Crockett CJ, Zeigler LN, Kynes JM, Lawson KC, Figueroa LI, Hayes CB, et al. A prospective observational study of postoperative follow-ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala. Pediatr Anesth. 2020;30:469-79. doi: 10.1111/pan.13830.

Corno AF. Pediatric and congenital cardiac surgery in emerging economies: surgical “safari” versus educational programs . Interact Cardiovasc Thorac Surg. 2016;23:163-70. doi: 10.1093/icvts/ivw069.

Bitter CC, Dornbush C, Khoyilar C, Hull C, Elsner-Boldt H, Mainali S, et al. A Short-Term Medical Mission in Rural Nepal: Chief Complaints, Medications Dispensed, and Unmet Health Needs. Cureus. 2021;13. doi: 10.7759/CUREUS.15427.

Coughran AJ, Merrell SB, Pineda C, Sceats LA, Yang GP, Morris AM. Local and Visiting Physician Perspectives on Short Term Surgical Missions in Guatemala: A Qualitative Study. Ann Surg. 2021;273:606-12. doi: 10.1097/SLA.0000000000003292.

Peiffer S, Ssentongo AE, Keeney L, Amponsah-Manu F, Yeboako R, Ofosu-Akromah R, et al. Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana. BMC Surg. 2020;20:211. doi: 10.1186/s12893-020-00867-9.

Agarwal PK. Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males. Cureus. 2023;15:e38053. doi: 10.7759/cureus.38053.

Rahul BG, Ravindranath GG. Incidence of inguinal hernia and its type in a study in a semiurban area in Andhra Pradesh, India. Int Surg J. 2016;3:1946-9. doi: 10.18203/2349-2902.isj20163184.

Ho IG, Ihn K, Koo E-J, Oh J-T. A study of contralateral persistent processus vaginalis in laparoscopic hernia repair in children. Hernia. 2019;23:783-7. doi: 10.1007/s10029-019-01895-y.

Koo E, Jung E. Laparoscopic totally extraperitoneal ligation for pediatric inguinal hernia: a novel surgical treatment. Surg Endosc. 2022;36:1320-5. doi: 10.1007/s00464-021-08408-y.

Nethaji K, Kumari R, Jaiswal P, Jha PK, Ranjan R, Akela A. Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair. Cureus. 2023;15:e39420. doi: 10.7759/cureus.39420.

Pilkington JJ, Obeidallah MR, Zahid MS, Stathakis P, Siriwardena AK, Jamdar S, et al. Outcome of the “Manchester Groin Repair” (Laparoscopic Totally Extraperitoneal Approach With Fibrin Sealant Mesh Fixation) in 434 Consecutive Inguinal Hernia Repairs. Front Surg. 2018;5. doi: 10.3389/fsurg.2018.00053.

Jarrard JA, Arroyo MR, Moore BT. Occult contralateral inguinal hernias: what is their true incidence and should they be repaired? Surg Endosc. 2019;33:2456-8. doi: 10.1007/s00464-018-6528-y.

Ademuyiwa AO, Bode CO, Desalu I, Elebute OA, Olatosi JO, Temiye E. Routine haemoglobin electrophoresis screening in day case herniotomy in Nigerian children: Is it evidence-based? Niger Med J. 2013;54:408-10. doi: 10.4103/0300-1652.126297.

Erdoğan D, Karaman İ, Aslan MK, Karaman A, Çavuşoğlu YH. Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center. J Pediatr Surg. 2013;48:1767-72. doi: 10.1016/j.jpedsurg.2012.09.048.

Chu CB, Chen J, Shen YM, Liu SJ, Sun L, Nie YS, et al. Individualized treatment of pediatric inguinal hernia reduces adolescent recurrence rate: an analysis of 3006 cases. Surg Today. 2020;50(5):499-508. doi: 10.1007/s00595-019-01940-4.

Aneiros Castro B, Cano Novillo I, García Vázquez A, De Miguel Moya M. Is the Laparoscopic Approach Safe for Inguinal Hernia Repair in Preterms? J Laparoendosc Adv Surg Tech A. 2019;29(10):1302-5. doi: 10.1089/lap.2019.0116.

Hammoud M, Gerken J. Inguinal Hernia. StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

Abantanga F, Hesse A, Sory E, Osen H, Choo S, Abdullah F, et al. Policies for Improving Access to and Quality of Basic and Essential Surgical Care at District Hospitals in Ghana. Postgrad Med J Ghana. 2022;1(1):3-8. doi: 10.60014/pmjg.v1i1.12.