Uptake and factors affecting utilisation of minimal access surgery by gynaecologists in Uganda

Abstract

Background: Minimal access surgery (MAS) has several proven benefits for the management of most of the gynaecological conditions. However, there is limited data on the uptake and factors affecting utilization of these techniques by gynaecologists in Uganda. Therefore, we aimed to determine the utilization of MAS and associated factors among the gynaecologists in Uganda. Objective: To assess the utilization and identify factors affecting the use of MAS by gynaecologists in Uganda. Methods: This was a mixed-methods study conducted from january to april 2024 involving a quantitative cross-sectional and qualitative approach conducted among gynaecologists registered with the Uganda Medical and Dental Practitioners Council and in active practice in public and private hospitals in Uganda. Participants inaccessible via online media channels or physically at the time of the study were excluded. The sample size was calculated using Slovin’s formula for the fine population and 182 gynaecologists systematically sampled. An online questionnaire was administered through e-mail or WhatsApp phone numbers and physical questionnaire were self-administered. Data was analysed using STATA Version 14 software and presented in tables. Qualitative data was collected through conducting key informants’ interview of the five purposively selected gynaecologists. This was written on paper and audio recorded, transcribed verbatim, coded and themes developed. Significance: The study results has yielded valuable insights for training institutions, policy makers, and implementers in Uganda. Results: A total of 160 participants, male 131 (82.0%), female 29(18.0), Overall, in the past one year, 30 (18.8%) performed MAS as primary surgeons, and 64 (40%) as both primary and/or assistant surgeon. Of the 64, 40 (62.5%) performed MAS in private not for profit hospitals. The most significant factors facilitating the uptake of MAS include budget allocation for MAS log odds 3.139, 95% CI 0.360388 – 5.918705, pv 0.027, practicing in private hospital log odds 4.403, 95% CI -0.19501 – 9.001383, pv 0.061, practicing at the national referral hospital log odds 5.320, 95% CI -0.42596 – 11.06614, pv 0.07 and the barrier is lack of supplies and utilities log odds -4.87448, 95% CI -10.1012 – 0.352214, pv 0.068. Qualitatively, a number of themes emerged as barriers to perform MAS: Lack of expertise, high cost of equipment’s, lack of institutional support meanwhile facilitators included: training, supportive hospital administration, team work and cost sharing. Conclusion: We found that 1 in 5 practicing gynaecologists practice MAS as a primary surgeon and commonly practiced in private not for profit hospitals. Findings from this study highlights valuable insights for training institutions, policy makers, and implementers.