Key to reducing maternal mortality is to ensure that, when needed, women have access to emergency obstetric care, including the capacity to surgically deliver her baby. This point at times get lost with the justified focus on family planning, skilled birth attendants, and facility-based births. As I have highlighted on this blog before, the accessibility of safe surgery is poor in many developing countries and is likely limiting the availability of such life saving technologies.
In this past week’s lancet, there is another excellent study that points to the need for increased investment in surgical infrastructure. The metrics available to measure and monitor surgical availability is poor – no surprise – but the authors of a new study have used the availability pulse oximetry as a “proxy for adequacy of operating theatre equipment supply because of this scarcity in low-income settings, and because international organisations such as the World Federation of Societies of Anaesthesiologists (WFSA) and WHO regard it as essential for safe anaesthesia and surgery.” Sounds reasonable.
The estimated number of operating theatres ranged from 1·0 (95% CI 0·9–1·2) per 100 000 people in west sub-Saharan Africa to 25·1 (20·9–30·1) per 100000 in eastern Europe. High-income subregions all averaged more than 14 per 100000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100 000. Pulse oximetry data from 54 countries suggested that around 77 700 (63 195–95 533) theatres worldwide (19·2% [15·2–23·9]) were not equipped with pulse oximeters.
Obviously, making a pulse oximetry machine available is not a perfect measure of the capacity to conduct safe surgery (interestingly, it turns out one can even purchase such machines on Amazon should one ever desire one). Surgery is complicated. Not only to you need some basic machines, but you also need a surgeon, anesthesia, a sterile environment, functioning equipment, a reliable blood supply and other items. But if basic equipment is not there, it suggests that the rest is also lacking. This study highlights how challenging, and different, addressing this health priority will be relative to simpler health interventions.