• J Gajewski, E Borgstein, L Bijlmakers, G Mwapasa, Z Aljohani, C Pittalis, T McCauley, and R Brugha.
• Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
• Br J Surg. 2019 Jan 1; 106 (2): e156-e165.

BackgroundShortages of specialist surgeons in African countries mean that the needs of rural populations go unmet. Task-shifting from surgical specialists to other cadres of clinicians occurs in some countries, but without widespread acceptance. Clinical Officer Surgical Training in Africa (COST-Africa) developed and implemented BSc surgical training for clinical officers in Malawi.MethodsTrainees participated in the COST-Africa BSc training programme between 2013 and 2016. This prospective study done in 16 hospitals compared crude numbers of selected numbers of major surgical procedures between intervention and control sites before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals between the COST-Africa trainees and other surgically active cadres.ResultsSeventeen trainees participated in the COST-Africa BSc training. The volume of surgical procedures undertaken at intervention hospitals almost doubled between 2013 and 2015 (+74 per cent), and there was a slight reduction in the number of procedures done in the control hospitals (-4 per cent) (P = 0·059). In the intervention hospitals, general surgery procedures were more often undertaken by COST-Africa trainees (61·2 per cent) than other clinical officers (31·3 per cent) and medical doctors (7·4 per cent). There was no significant difference in postoperative wound infection rates for hernia procedures at intervention hospitals between trainees and medical doctors (P = 0·065).ConclusionThe COST-Africa study demonstrated that in-service training of practising clinical officers can improve the surgical productivity of district-level hospitals.© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.

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