Does Training in Surgical Skills of Clinical Officers in the Southern Region of Malawi Reduce Number of Surgical Referrals from District Government and CHAM Hospitals to Central Hospitals?

Abstract

Introduction : Central Hospitals in Malawi are still being overwhelmed by surgical referrals from district hospitals which are mainly manned by Clinical officers. A training programme was implemented for Clinical officers with the aim of reducing improving their skills and confidence in surgery. This study sought to assess the impact of this program on surgical referrals. Objective: To assess the impact on surgical referrals after training of the Clinical officers in surgical skills in the southern region government and CHAM hospitals. Design: Hospital based and 4 weeks attachment at MCHS of all enrolled Clinical Officers. This is a before and after study following a cohort of 22 Clinical officers 8 government and 6 CHAM hospitals in the southern region of Malawi. Results: Of 5243 surgical patients collected in the ward from 2004 records 199 patients, representing 3.9% (95% confidence interval: 3.4 – 4.5) were referred to central hospitals for further management. The same data collected in 2005 after the training shows that of 4902 surgical admissions 141 (2.9%) were referred. This figure has a 95% confidence interval of 2.4 – 3.4 meaning that although there is an apparent decline in the referrals the change was still not significant. The major referral diagnoses were trauma of all forms with 36 (17.6%) cases and bowel obstruction with 34 (16.6%) cases. Conclusion: This study has demonstrated that the lack of surgical skills in handling trauma and bowel obstruction cases leads to most referrals. The emphasis of the program should therefore mainly focus on bowel surgery and handling of accidents and emergencies.