Assessment of diagnostics capacity in hospitals providing surgical care in two Latin American states

Lina Roa; Ellie Moeller; Zachary Fowler; Rodrigo Vaz Ferreira; Sebastian Mohar; Tarsicio Uribe-Leitz; Aline Gil Alves Guilloux; Alejandro Mohar; Robert Riviello; John G Meara; Jose Emerson Dos Santos Souza; Valeria Macias

doi:10.1016/j.eclinm.2020.100620

Assessment of diagnostics capacity in hospitals providing surgical care in two Latin American states

EClinicalMedicine. 2020 Nov 5:29-30:100620. doi: 10.1016/j.eclinm.2020.100620. eCollection 2020 Dec.

Authors

Lina Roa^{1

2}, Ellie Moeller¹, Zachary Fowler¹, Rodrigo Vaz Ferreira³, Sebastian Mohar^{4

5}, Tarsicio Uribe-Leitz^{1

6}, Aline Gil Alves Guilloux⁷, Alejandro Mohar⁸, Robert Riviello^{1

6}, John G Meara^{1

9}, Jose Emerson Dos Santos Souza³, Valeria Macias⁵

Affiliations

¹ Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115 United States.
² Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada, 220 Heritage Medical Research Centre, Edmonton, AB.
³ Universidade do Estado do Amazonas, Av. Djalma Batista, 3578 - Flores, Manaus - AM, 69055-010, Brazil.
⁴ Hospital Básico Comunitario Angel Albino Corzo, Calle Quinta Pte. Nte. 410, Emiliano Zapata, 30370 Jaltenango de la Paz, Chiapas, Mexico.
⁵ Compañeros en Salud, Calle Primera Pte. Sur 25, Centro, 30370, Angel Albino Corzo, Chiapas, Mexico.
⁶ Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA,02120 United States.
⁷ Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo - SP, 01246-903, Brazil.
⁸ Unidad de Epdemiología e Investigación Biomédica en Cáncer. Instituto Nacional de Cancerología, Universidad Nacional Autonoma de Mexico Mexico.
⁹ Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 USA.

Abstract

Background: Diagnostic services are an essential component of high-quality surgical, anesthesia and obstetric (SAO) care. Efforts to scale up SAO care in Latin America have often overlooked diagnostics capacity. This study aims to analyze the capacity of diagnostic services, including radiology, pathology, and laboratory medicine, in hospitals providing SAO care in the states of Chiapas, Mexico and Amazonas, Brazil.

Methods: A stratified cross-sectional evaluation of diagnostic capacity in hospitals performing surgery in Chiapas and Amazonas was performed using the Surgical Assessment Tool (SAT). National data sources were queried for indicators of diagnostics capacity in terms of workforce, infrastructure and diagnosis utilization. Fisher's exact tests and chi-square tests were used to compare categorical variables between the private and public sector in Chiapas while descriptive statistics are used to compare Amazonas and Chiapas.

Findings: In Chiapas, 53% (n = 17) of public and 34% (n = 20) of private hospitals providing SAO care were assessed. More private hospitals than public hospitals could always provide x-rays (35% vs 23.5%) and ultrasound (85% vs 47.1%). However neither sector could consistently perform basic laboratory testing such as complete blood counts (70.6% public, 65% private). In Amazonas, 30% (n = 18) of rural hospitals were surveyed. Most had functioning x-ray machine (77.8%) and ultrasound (55.6%). The majority of hospitals could provide complete blood count (66.7%) but only one hospital (5.6%) could always perform an infectious panel. Both Chiapas and Amazonas had dramatically fewer diagnostic practitioners per capita in each state compared to the national average capacity.

Interpretation: Facilities providing SAO care in low-resource states in Mexico and Brazil often lack functioning diagnostics services and workforce. Scale-up of diagnostic services is essential to improve SAO care and should occur with emphasis on equitable and adequate resource allocation.

Keywords: Diagnostics; Global surgery; Health systems; Laboratory medicine; Pathology; Radiology.