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Trends in neurosurgical care in Western Uganda: an interrupted time series analysis.

Publication ,  Journal Article
Abdelgadir, J; Elahi, C; Corley, J; Wall, KC; Najjuma, JN; Muhindo, A; Nickenig Vissoci, JR; Haglund, MM; Kitya, D
Published in: Neurosurg Focus
October 2018

OBJECTIVE: In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University. METHODS: An interrupted time series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. The authors applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. They used segmented regression and autoregressive integrated moving average models for the analysis. RESULTS: Over the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p value = 0.0039). CONCLUSIONS: This interrupted time series analysis study showed improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including the addition of a part-time neurosurgeon, improvement in infrastructure, and increased experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.

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Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

October 2018

Volume

45

Issue

4

Start / End Page

E15

Location

United States

Related Subject Headings

  • Uganda
  • Surgery Department, Hospital
  • Retrospective Studies
  • Referral and Consultation
  • North Carolina
  • Neurosurgical Procedures
  • Neurosurgery
  • Neurology & Neurosurgery
  • Interrupted Time Series Analysis
  • Internship and Residency
 

Citation

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Abdelgadir, J., Elahi, C., Corley, J., Wall, K. C., Najjuma, J. N., Muhindo, A., … Kitya, D. (2018). Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus, 45(4), E15. https://doi.org/10.3171/2018.7.FOCUS18270
Abdelgadir, Jihad, Cyrus Elahi, Jacquelyn Corley, Kevin C. Wall, Josephine N. Najjuma, Alex Muhindo, Joao Ricardo Nickenig Vissoci, Michael M. Haglund, and David Kitya. “Trends in neurosurgical care in Western Uganda: an interrupted time series analysis.Neurosurg Focus 45, no. 4 (October 2018): E15. https://doi.org/10.3171/2018.7.FOCUS18270.
Abdelgadir J, Elahi C, Corley J, Wall KC, Najjuma JN, Muhindo A, et al. Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus. 2018 Oct;45(4):E15.
Abdelgadir, Jihad, et al. “Trends in neurosurgical care in Western Uganda: an interrupted time series analysis.Neurosurg Focus, vol. 45, no. 4, Oct. 2018, p. E15. Pubmed, doi:10.3171/2018.7.FOCUS18270.
Abdelgadir J, Elahi C, Corley J, Wall KC, Najjuma JN, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus. 2018 Oct;45(4):E15.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

October 2018

Volume

45

Issue

4

Start / End Page

E15

Location

United States

Related Subject Headings

  • Uganda
  • Surgery Department, Hospital
  • Retrospective Studies
  • Referral and Consultation
  • North Carolina
  • Neurosurgical Procedures
  • Neurosurgery
  • Neurology & Neurosurgery
  • Interrupted Time Series Analysis
  • Internship and Residency