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Background The expansion of local training programmes is crucial to address the shortages of specialist paediatric surgeons across Sub-Saharan Africa. This study assesses whether the current training programme for paediatric surgery at the College of Surgeons of East, Central and Southern Africa (COSECSA) is exposing trainees to adequate numbers and types of surgical procedures, as defined by local and international guidelines. Methods Using data from the COSECSA web-based logbook, we retrospectively analysed numbers and types of operations carried out by paediatric surgical trainees at each stage of training between 2015 and 2019, comparing results with indicative case numbers from regional (COSECSA) and international (Joint Commission on Surgical Training) guidelines. Results A total of 7,616 paediatric surgical operations were recorded by 15 trainees, at different stages of training, working across five countries in Sub-Saharan Africa. Each trainee recorded a median number of 456 operations (range 56–1111), with operative experience increasing between the first and final year of training. The most commonly recorded operation was inguinal hernia ( n  = 1051, 13.8%). Trainees performed the majority ( n  = 5607, 73.6%) of operations recorded in the eLogbook themselves, assisting in the remainder. Trainees exceeded both local and international recommended case numbers for general surgical procedures, with little exposure to sub-specialities. Conclusions Trainees obtain a wide experience in common and general paediatric surgical procedures, the number of which increases during training. Post-certification may be required for those who wish to sub-specialise. The data from the logbook are useful in identifying individuals who may require additional experience and centres which should be offering increased levels of supervised surgical exposure.

Background Congenital anomalies, encompassing structural or functional defects present at birth, pose a significant global health challenge. Addressing congenital anomalies can contribute significantly to further reducing neonatal mortality and advancing overall child health in Ethiopia. Objective This study aimed to assess the magnitude, pattern, birth outcome, and determinants of congenital anomalies among newborns in Ethiopia. Methods Employing a facility-based cross-sectional design over one month, the study enrolled 813 deliveries attending two public and private maternal and child health centers. We used consecutive sampling of all eligible deliveries who fulfils the inclusion criteria during the study period and meticulously screened for congenital anomalies using a well-designed pictorialized data collection tool by training pediatricians and midwives. To determine the strength of the association and identify independent predictors of birth defects, the adjusted odds ratio (AOR) and 95% confidence interval were computed using binary logistic regression analysis. Results Forty-six neonates (5.66%, 95% CI: 4.17%–7.47%) had one or more congenital anomalies detected on physical examination. Of these, 36 had a single anomaly, while 10 had multiple malformations. There were a combined 60 anomalies among the 46 newborn babies. The majority of the patients had central nervous system anomalies (31.7%), followed by genitourinary system (25.4%) and musculoskeletal system (22.2%) anomalies. The odds of birth defects increased by 3.73 for women attending a private hospital compared to those attending a public hospital (AOR 3.73, 95% CI 1.67, 8.32). The odds of birth defects were 1.97 times greater for males than for females (AOR 1.97, 95% CI 0.99, 3.91; p  = 0.051), which is clinically or practically significant even if the p value is slightly above the cutoff point, 0.05. The odds of birth defects were found to be 9.3 times greater among neonates with very low birth weight and low birth weight than among neonates with appropriate birth weight (AOR 9.29, 95% CI 3.41, 25.31). Primipara women had 3.64 times greater odds of delivering babies with birth defects than did multipara women (AOR 3.64, 95% CI 1.45, 9.13). In this study, perinatal mortality was markedly higher among newborns with congenital anomalies (37%) compared to those without anomalies (1%), and this difference was statistically significant ( p  < 0.001). Conclusion In conclusion, this study provides important insights into the prevalence, patterns, birth outcomes, and predictors of congenital anomalies. The high anomaly rates highlight the need for comprehensive prenatal care, including early diagnosis, risk factor monitoring, and targeted interventions for private MCH clinics, male neonates, low birth weight infants, and primipara women. Further longitudinal research and collaboration with the Ministry of Health to establish a congenital anomaly surveillance system can improve the understanding and management of these conditions.

Background In East, Central and Southern Africa accurate data on the current surgeon workforce have previously been limited. In order to ensure that the workforce required for sustainable delivery of surgical care is put in place, accurate data on the number, specialty and distribution of specialist-trained surgeons are crucial for all stakeholders in surgery and surgical training in the region. Methods The surgical workforce in each of the ten member countries of the College of Surgeons of East, Central and Southern Africa (COSECSA) was determined by gathering and crosschecking data from multiple sources including COSECSA records, medical council registers, local surgical societies records, event attendance lists and interviews of Members and Fellows of COSECSA, and validating this by direct contact with the surgeons identified. This data was recorded and analysed in a cloud-based computerised database, developed as part of a collaboration programme with the Royal College of Surgeons in Ireland. Results A total of 1690 practising surgeons have been identified yielding a regional ratio of 0.53 surgeons per 100,000 population. A majority of surgeons (64 %) practise in the main commercial city of their country of residence and just 9 % of surgeons are female. More than half (53 %) of surgeons in the region are general surgeons. Conclusions While there is considerable geographic variation between countries, the regional surgical workforce represents less than 4 % of the equivalent number in developed countries indicating the magnitude of the human resource challenge to be addressed.

In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a \"flooding\" policy. To assess medical student perceptions on the impact of the \"flooding\" policy on medical education and e-learning initiatives, as well as plans for future emigration. A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration. 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the \"flooding\" policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet connectivity. Most preclinical students (85.1%) who had attended live-streamed lectures preferred traditional classroom lectures. Half of the students (49.5%) intended to practice medicine in Ethiopia. Independent risk factors for planning to emigrate included age <21 years (aOR = 1.30, 95% CI 1.04, 1.97); having applied to medical school for reasons other than \"wanting to be a physician\" (aOR = 1.55, 95% CI 1.14, 2.20), and not believing that \"flooding\" policy would increase the number of physicians working in Ethiopia (aOR = 1.87, 95% CI 1.33, 2.58). The \"flooding\" policy lead to significant educational challenges that were not fully alleviated by e-learning initiatives. Concomitant increases in resources for infrastructure development and faculty expansion are needed to maintain quality medical education. Additional research is needed on factors that influence medical graduates decision to emigrate.

Background As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. Methods 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delphi technique to identify potential recommendations, assess agreement with proposed recommendations and address items not meeting consensus. Results From an initial 29 recommendations identified in the first round, 12 were identified for inclusion in the second round. After discussion of recommendations without consensus for inclusion or exclusion, four additional recommendations were added for an eventual 16 recommendations. Nine of these recommendations were related to checklist content, while seven recommendations were related to implementation. Conclusions This multinational panel has identified 16 recommendations for sites looking to use the surgical safety checklist during the COVID-19 pandemic. These recommendations provide an example of how the SSC can adapt to meet urgent and emerging needs of surgical systems by targeting important processes and encouraging critical discussions.

Background A rapid transition from severe physician workforce shortage to massive production to ensure the physician workforce demand puts the Ethiopian health care system in a variety of challenges. Therefore, this study discovered how the health system response for physician workforce shortage using the so-called flooding strategy was viewed by different stakeholders. Methods The study adopted the grounded theory research approach to explore the causes, contexts, and consequences (at the present, in the short and long term) of massive medical student admission to the medical schools on patient care, medical education workforce, and medical students. Forty-three purposively selected individuals were involved in a semi-structured interview from different settings: academics, government health care system, and non-governmental organizations (NGOs). Data coding, classification, and categorization were assisted using ATLAs.ti qualitative data analysis scientific software. Results In relation to the health system response, eight main categories were emerged: (1) reasons for rapid medical education expansion; (2) preparation for medical education expansion; (3) the consequences of rapid medical education expansion; (4) massive production/flooding as human resources for health (HRH) development strategy; (5) cooperation on HRH development; (6) HRH strategies and planning; (7) capacity of system for HRH development; and (8) institutional continuity for HRH development. The demand for physician workforce and gaining political acceptance were cited as main reasons which motivated the government to scale up the medical education rapidly. However, the rapid expansion was beyond the capacity of medical schools’ human resources, patient flow, and size of teaching hospitals. As a result, there were potential adverse consequences in clinical service delivery, and teaching learning process at the present: “the number should consider the available resources such as number of classrooms, patient flows, medical teachers, library…” . In the future, it was anticipated to end in surplus in physician workforce, unemployment, inefficiency, and pressure on the system: “…flooding may seem a good strategy superficially but it is a dangerous strategy. It may put the country into crisis, even if good physicians are being produced; they may not get a place where to go…” . Conclusion Massive physician workforce production which is not closely aligned with the training capacity of the medical schools and the absorption of graduates in to the health system will end up in unanticipated adverse consequences.

To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96). A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.

BackgroundThe African Forum for Health Education and Research human immunodeficiency virus management training (AFREhealth HIV) project was launched in 2019. The project offers a reimagined model for interprofessional training and mentorship to improve clinical care and equip healthcare workers with the technical knowledge and clinical tools to respond to HIV and other health issues.AimThe study aims to evaluate learners’ experiences of interprofessional health workforce capacity building across sub-Saharan Africa (SSA) to enhance HIV management.SettingParticipants included pre-service medical and nursing students and early career professionals (learners). Learners were associated with 14 AFREhealth partners in 11 SSA countries.MethodsLearners attending AFREhealth HIV training workshops were invited to provide feedback using a standardised online form, which included 28 Likert-type questions and 3 open-ended questions. Analysis of the 3 open-ended questions was done by coding responses into a set of common themes and sub-themes.ResultsFindings showed that of the 3711 learners who participated, only 2570 completed the post-training evaluation. Findings also showed that the learners appreciated the approach adopted in the workshops and believed they gained significant knowledge and skills for themselves. The importance of collaborative, team-based and interprofessional approaches throughout the training was highlighted.ConclusionThe training approach adopted by the AFREhealth HIV project has proven to be highly effective. The project has thus continued to target final-year health professional students and working health professionals at affiliated training sites, with module workshops being offered both online and onsite.ContributionCollaborative and interprofessional approaches to training health professionals for HIV management can improve knowledge, skills and, very importantly, attitudes, with the potential thus to improve the quality of team-based care provided especially in low-resource settings.

Background The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia. Methodology A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms. Results A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%. Conclusion We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.

Background A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource–constrained settings. Methods We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey ( n  = 25) and qualitative data through in-depth interviews ( n  = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. Results All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. Conclusion We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention’s success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.