A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of...A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.展开更多
Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because o...Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.展开更多
To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Googl...To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove criti展开更多
Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities su...Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks;inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.展开更多
Background: A recent survey of in-hospital reprocessing in Tanzanian hospitals identified bag-valve masks (BVM) as a commonly reused single-use device. In low- and middle-income countries (LMIC), in-hospital reprocess...Background: A recent survey of in-hospital reprocessing in Tanzanian hospitals identified bag-valve masks (BVM) as a commonly reused single-use device. In low- and middle-income countries (LMIC), in-hospital reprocessing supports neonatal resuscitation strategies by helping to maintain adequate supplies of BVM. However, there is a need for device-specific protocols defining reprocessing procedures and inspection criteria to overcome variations in reprocessing practices between hospitals. The purposes of this study were: 1) to complete a comprehensive design review and identify challenges to reprocessing BVMs;and 2) to investigate three different residual bioburden analysis methods for assessing the efficacy of decontaminating a disposable BVM. Methods: New, unused bag-valve-masks were contaminated with Staphylococcus epidermidis and Artificial Mucus Soil to simulate the worst case soiling conditions. Devices underwent one of five disinfection protocols, including one currently used in a LMIC hospital. Three analytical (two quantitative and one qualitative) methods were selected to evaluate residual bioburden on the device following decontamination. Results: Of all protocols tested, only the positive control and the Soap and Bleach protocols met disinfection targets. Most cleaning outcomes were consistent from trial to trial for each protocol. However, cleaning outcomes varied greatly for the Alcohol Wipe protocol. For the residual bioburden analyses, the two quantitative methods produced similar results, but the qualitative measurement exhibited increased variability. Conclusion: While this study revealed positive disinfection outcomes for the Tanzanian hospital decontamination protocol, more studies are required to support these findings. Design features of the BVM mask presented challenges to cleaning and drying during different decontamination protocols, as seen in the variability in the Alcohol Wipe protocol performance. These findings support the case for a device-specific protocol for the BVM. Given proper 展开更多
The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a prof...The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.展开更多
<strong><em>Background</em>:</strong> The purpose of this paper is to report the perceptions of continuous professional development by the nurses and midwives in a low resource country. These f...<strong><em>Background</em>:</strong> The purpose of this paper is to report the perceptions of continuous professional development by the nurses and midwives in a low resource country. These findings are part of a larger study on the experiences of nurses and midwives providing postpartum care in rural areas of Kenya. Besides being the main healthcare providers in rural areas, nurses in low resource countries have limited access to continuous professional development. <strong><em>Research design</em>:</strong> This is a qualitative research guided by critical theory and Foucault’s concepts of power and knowledge. Focused ethnography provided the framework of data collection and analysis. 23 in-depth interviews were contacted, and thematic analysis was used for data analysis. Reflexive memos kept throughout the research process helped to ensure the trustworthiness of data. <strong><em>Findings</em>:</strong> This paper will focus on the theme of continuing professional development (CPD) as a resource for a healthy work environment. While the knowledge of the nurses and midwives allowed them to provide care to the mothers and their infants adequately, personal and structural barriers prevented them from participating in continuing professional development. <strong><em>Discussion and Conclusion</em>:</strong> A well-prepared nursing and midwifery workforce could have the capacity to transform the health outcomes of their clients through the application of evidence-based practices. Therefore, courses that are context-appropriate and meet the needs of different learners should be available to support the nurses’ and midwives’ professional growth. There is a need for more research on the nurses’ and midwives’ participation in CPD in Kenya, and the effect of CPD on specific health outcomes.展开更多
Breast cancer is one of the leading causes of cancer deaths among women[1].In the past 40 years,breast cancer incidence has doubled or even tripled in developed countries such as South Korea and Japan; whereas it is a...Breast cancer is one of the leading causes of cancer deaths among women[1].In the past 40 years,breast cancer incidence has doubled or even tripled in developed countries such as South Korea and Japan; whereas it is about 20% to 30% in China and India in the past decade[2-4]. An increasing incidence rate of 3%展开更多
当人类的健康系统面临来自于医疗资源和经济等多方面的挑战时,健康信息技术(health information technology,HIT)有时可以帮助我们解决问题。然而,关于广泛应用HIT的相关证据仍不全面。中低收入国家的医疗基础设施和医疗保健水平相对薄...当人类的健康系统面临来自于医疗资源和经济等多方面的挑战时,健康信息技术(health information technology,HIT)有时可以帮助我们解决问题。然而,关于广泛应用HIT的相关证据仍不全面。中低收入国家的医疗基础设施和医疗保健水平相对薄弱,因此我们希望能从有着良好医疗保健基础的发达国家获取在呼吸病领域的应用经验,总结其失败的教训,为如何使HIT应用利益最大化提供建议。高收入地区研究应用HIT给我们的启示就是应在疾病负担适当的人群中开展低成本且技术成熟的研究,同时仔细评估其安全性。展开更多
目的:通过系统性回顾分析中低收入国家5岁以下儿童初级卫生保健服务干预措施的有效性,旨在为进一步提升中低收入国家儿童健康服务的有效性提供有效建议。方法:在Embase、PubMed、Cochrane图书馆和Web of Science 4个数据库中,按照参与...目的:通过系统性回顾分析中低收入国家5岁以下儿童初级卫生保健服务干预措施的有效性,旨在为进一步提升中低收入国家儿童健康服务的有效性提供有效建议。方法:在Embase、PubMed、Cochrane图书馆和Web of Science 4个数据库中,按照参与者(5岁以下儿童)、干预措施、结果测量、国家和研究设计对检索词进行组织,检索发表时间为2000年1月—2021年6月的文献,同时,也对国际组织的资料和灰色文献进行了人工检索。结果:共纳入11篇符合标准的研究,均为评估促进中低收入国家5岁以下儿童初级卫生保健服务利用情况的干预研究。审查结果表明,综合社区个案管理和取消用户付费这两项干预措施在提高5岁以下儿童接受初级卫生保健服务和寻求护理方面表现出了积极作用。结论:建议进行更多的随机对照试验来评估所有的儿童健康干预措施,并对数据质量采取额外的预防措施。展开更多
Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal...Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.展开更多
基金Supported by The Belgian Directorate for Development Cooperation through the Institute of Tropical Medicine,Antwerp
文摘A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.
文摘Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
文摘To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove criti
文摘Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks;inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.
文摘Background: A recent survey of in-hospital reprocessing in Tanzanian hospitals identified bag-valve masks (BVM) as a commonly reused single-use device. In low- and middle-income countries (LMIC), in-hospital reprocessing supports neonatal resuscitation strategies by helping to maintain adequate supplies of BVM. However, there is a need for device-specific protocols defining reprocessing procedures and inspection criteria to overcome variations in reprocessing practices between hospitals. The purposes of this study were: 1) to complete a comprehensive design review and identify challenges to reprocessing BVMs;and 2) to investigate three different residual bioburden analysis methods for assessing the efficacy of decontaminating a disposable BVM. Methods: New, unused bag-valve-masks were contaminated with Staphylococcus epidermidis and Artificial Mucus Soil to simulate the worst case soiling conditions. Devices underwent one of five disinfection protocols, including one currently used in a LMIC hospital. Three analytical (two quantitative and one qualitative) methods were selected to evaluate residual bioburden on the device following decontamination. Results: Of all protocols tested, only the positive control and the Soap and Bleach protocols met disinfection targets. Most cleaning outcomes were consistent from trial to trial for each protocol. However, cleaning outcomes varied greatly for the Alcohol Wipe protocol. For the residual bioburden analyses, the two quantitative methods produced similar results, but the qualitative measurement exhibited increased variability. Conclusion: While this study revealed positive disinfection outcomes for the Tanzanian hospital decontamination protocol, more studies are required to support these findings. Design features of the BVM mask presented challenges to cleaning and drying during different decontamination protocols, as seen in the variability in the Alcohol Wipe protocol performance. These findings support the case for a device-specific protocol for the BVM. Given proper
文摘The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.
文摘<strong><em>Background</em>:</strong> The purpose of this paper is to report the perceptions of continuous professional development by the nurses and midwives in a low resource country. These findings are part of a larger study on the experiences of nurses and midwives providing postpartum care in rural areas of Kenya. Besides being the main healthcare providers in rural areas, nurses in low resource countries have limited access to continuous professional development. <strong><em>Research design</em>:</strong> This is a qualitative research guided by critical theory and Foucault’s concepts of power and knowledge. Focused ethnography provided the framework of data collection and analysis. 23 in-depth interviews were contacted, and thematic analysis was used for data analysis. Reflexive memos kept throughout the research process helped to ensure the trustworthiness of data. <strong><em>Findings</em>:</strong> This paper will focus on the theme of continuing professional development (CPD) as a resource for a healthy work environment. While the knowledge of the nurses and midwives allowed them to provide care to the mothers and their infants adequately, personal and structural barriers prevented them from participating in continuing professional development. <strong><em>Discussion and Conclusion</em>:</strong> A well-prepared nursing and midwifery workforce could have the capacity to transform the health outcomes of their clients through the application of evidence-based practices. Therefore, courses that are context-appropriate and meet the needs of different learners should be available to support the nurses’ and midwives’ professional growth. There is a need for more research on the nurses’ and midwives’ participation in CPD in Kenya, and the effect of CPD on specific health outcomes.
文摘Breast cancer is one of the leading causes of cancer deaths among women[1].In the past 40 years,breast cancer incidence has doubled or even tripled in developed countries such as South Korea and Japan; whereas it is about 20% to 30% in China and India in the past decade[2-4]. An increasing incidence rate of 3%
文摘当人类的健康系统面临来自于医疗资源和经济等多方面的挑战时,健康信息技术(health information technology,HIT)有时可以帮助我们解决问题。然而,关于广泛应用HIT的相关证据仍不全面。中低收入国家的医疗基础设施和医疗保健水平相对薄弱,因此我们希望能从有着良好医疗保健基础的发达国家获取在呼吸病领域的应用经验,总结其失败的教训,为如何使HIT应用利益最大化提供建议。高收入地区研究应用HIT给我们的启示就是应在疾病负担适当的人群中开展低成本且技术成熟的研究,同时仔细评估其安全性。
文摘目的:通过系统性回顾分析中低收入国家5岁以下儿童初级卫生保健服务干预措施的有效性,旨在为进一步提升中低收入国家儿童健康服务的有效性提供有效建议。方法:在Embase、PubMed、Cochrane图书馆和Web of Science 4个数据库中,按照参与者(5岁以下儿童)、干预措施、结果测量、国家和研究设计对检索词进行组织,检索发表时间为2000年1月—2021年6月的文献,同时,也对国际组织的资料和灰色文献进行了人工检索。结果:共纳入11篇符合标准的研究,均为评估促进中低收入国家5岁以下儿童初级卫生保健服务利用情况的干预研究。审查结果表明,综合社区个案管理和取消用户付费这两项干预措施在提高5岁以下儿童接受初级卫生保健服务和寻求护理方面表现出了积极作用。结论:建议进行更多的随机对照试验来评估所有的儿童健康干预措施,并对数据质量采取额外的预防措施。
文摘Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.
