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van Kesteren J, van Duinen AJ, Marah F, van Delft D, Spector AL, Cassidy LD, Groen RS, Jabbi SMBB, Bah S, Medo JA, Kamanda-Bongay A, van Leerdam D, Westendorp J, Mathéron HM, Mönnink GLE, Vas Nunes J, Lindenbergh KC, Hoel SK, Løvdal SM, Østensen MN, Solberg H, Boateng D, Klipstein-Grobusch K, van Herwaarden D, Martens JPJ, Bonjer HJ, Sankoh O, Grobusch MP, Bolkan HA. PREvalence Study on Surgical COnditions (PRESSCO) 2020: A Population-Based Cross-Sectional Countrywide Survey on Surgical Conditions in Post-Ebola Outbreak Sierra Leone. World J Surg 2022; 46:2585-2594. [PMID: 36068404 PMCID: PMC9529684 DOI: 10.1007/s00268-022-06695-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Background Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. Methods This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. Results A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4–7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. Conclusion PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013–2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06695-7.
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Affiliation(s)
- Jurre van Kesteren
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Foday Marah
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
| | - Diede van Delft
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
| | - Antoinette L Spector
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura D Cassidy
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Baltimore, USA
- SOS - Surgeons OverSeas, New York, NY, USA
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - James A Medo
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | | | - Daniel van Leerdam
- CapaCare, Trondheim, Norway
- KIT, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Hanna M Mathéron
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Giulia L E Mönnink
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Jonathan Vas Nunes
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Karel C Lindenbergh
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sara K Hoel
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sofie M Løvdal
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mia N Østensen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Helene Solberg
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Boateng
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - H Jaap Bonjer
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Martin P Grobusch
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
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2
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Qazi SH, Meerza SSA, Groen RS, Dogar SA, Mirani M, Jamali MK, Khan ZA, Padhani ZA, Bux R, Chahudary IA, Rizvi A, Islam S, Khan S, Ur Rashid RH, Abbas SA, Memon AS, Tabassum S, Dilawar B, Das JK. Assessment of pediatric surgical needs, health-seeking behaviors, and health systems in a rural district of Pakistan. PLOS Glob Public Health 2022; 2:e0000810. [PMID: 36962776 PMCID: PMC10021200 DOI: 10.1371/journal.pgph.0000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.
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Affiliation(s)
- Saqib Hamid Qazi
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Reinou S Groen
- Department of Obstetrics and Gynecology, Alaska Native Medical Center, Anchorage, Alaska
| | - Sohail Asghar Dogar
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mushtaq Mirani
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Muhammad Khan Jamali
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Zahid Ali Khan
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Zahra Ali Padhani
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Arjumand Rizvi
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Saleem Islam
- Department of Pediatric Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Rizwan Haroon Ur Rashid
- Section of Orthopedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Akbar Abbas
- Section of Head and Neck Surgery, Department of Surgery Aga Khan University, Karachi, Pakistan
| | - Abdul Sami Memon
- Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan
| | - Sadia Tabassum
- Section of Dermatology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Bakhtawar Dilawar
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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3
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Varela C, Viste A, Young S, Groen RS, Banza L, Nandi B, Mkandawire N, Moen BE. Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey. Malawi Med J 2021; 33:73-81. [PMID: 34777702 PMCID: PMC8560351 DOI: 10.4314/mmj.v33i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need. Aim To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries. Methods A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. Results There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. Conclusion An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.
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Affiliation(s)
- Carlos Varela
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Sven Young
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou S Groen
- Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bip Nandi
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, Blantyre, Malawi/Kamuzu University of Health Sciences
| | - Bente Elisabeth Moen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Hadley ME, Day G, Beans JA, Groen RS. Postpartum hemorrhage: Moving from response to prevention for Alaska Native mothers. Int J Gynaecol Obstet 2021; 155:290-295. [PMID: 34403505 PMCID: PMC9438451 DOI: 10.1002/ijgo.13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify risk factors for postpartum hemorrhage in a population of Alaska Native women. METHODS A case-control study of 384 women (128 cases, 256 controls) delivering between August 1, 2018, and July 31, 2019, was conducted at a Level III maternal referral center for Alaska Native women in Alaska. Risk factors were assessed via retrospective chart review, and bivariate and conditional regression analyses were conducted to determine odds ratios (ORs) between women with and without postpartum hemorrhage. RESULTS Body mass index ≥40 (OR 2.6, 95% confidence interval [CI] 1.4-4.5), antepartum bleeding (OR 6.3, 95% CI 1.2-31.6), previous postpartum hemorrhage (OR 5, 95% CI 2.6-9.8), suspected macrosomia (OR 2.7, 95% CI 1.4-5.3), macrosomia with birthweight ≥4000 g (OR 3.1, 95% CI 1.8-5.3), pre-eclampsia with magnesium sulfate (OR 4.0, 95% CI 2.0-8.0), length of third stage of labor >20 min (OR 2.2, 95% CI 1.1-4.4), oxytocin use >12 h (OR 5.4, 95% CI 2.0-14.6), residence in a rural community (OR 2.2, 95% CI 1.4-3.6), and vitamin D supplementation (OR 1.7, 95% CI 1.1-2.6) were associated with greater risk of postpartum hemorrhage. CONCLUSION Analysis of clinical and geographic risk factors for postpartum hemorrhage in Alaska Native women identified important targets for prevention.
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Affiliation(s)
- Megan E Hadley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Obstetrics and Gynecology, Southcentral Foundation, Anchorage, Alaska, USA
| | - Gretchen Day
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Julie A Beans
- Department of Research, Southcentral Foundation, Anchorage, Alaska, USA
| | - Reinou S Groen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Obstetrics and Gynecology, Southcentral Foundation, Anchorage, Alaska, USA
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5
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Varela C, Young S, Groen RS, Banza L, Mkandawire N, Moen BE, Viste A. Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey. BMC Public Health 2020; 20:1456. [PMID: 32977777 PMCID: PMC7519556 DOI: 10.1186/s12889-020-09575-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.
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Affiliation(s)
- Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou S Groen
- Department of Obstetrics and Gynaecology, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynaecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Bente Elisabeth Moen
- Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
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Wren SM, Wild HB, Gurney J, Amirtharajah M, Brown ZW, Bulger EM, Burkle FM, Elster EA, Forrester JD, Garber K, Gosselin RA, Groen RS, Hsin G, Joshipura M, Kushner AL, Norton I, Osmers I, Pagano H, Razek T, Sáenz-Terrazas JM, Schussler L, Stewart BT, Traboulsi AAR, Trelles M, Troke J, VanFosson CA, Wise PH. A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare. JAMA Surg 2020; 155:114-121. [PMID: 31722004 PMCID: PMC6865259 DOI: 10.1001/jamasurg.2019.4547] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Question What are consensus components of a framework for humanitarian surgical response in modern conflict zones? Findings This survey study using responses from 35 participants in the Stanford Humanitarian Surgical Response in Conflict Working Group suggests that humanitarian responses include both care of traumatic injury and emergency surgical needs of the population. Lessons from civilian and military trauma systems as well as humanitarian settings were translated into a tiered continuum of response from patient presentation through rehabilitation. Meaning Evidence suggests that modern trauma systems save lives but providing this standard of care in insecure conflict settings places new burdens on humanitarian systems; the framework presented herein integrates advances in surgical care to these environments. Importance Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures The working group’s method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.
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Affiliation(s)
- Sherry M Wren
- Stanford University School of Medicine, Stanford, California
| | - Hannah B Wild
- Stanford University School of Medicine, Stanford, California
| | - Jennifer Gurney
- US Army Institute of Surgical Research/Joint Trauma System, San Antonio, Texas
| | | | - Zachary W Brown
- Department of Surgery, Uniformed Services University, Bethesda, Maryland
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle.,Committee on Trauma, American College of Surgeons, Chicago, Illinois
| | - Frederick M Burkle
- Harvard T. H. Chan School of Public Health, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Eric A Elster
- Department of Surgery, Uniformed Services University, Bethesda, Maryland
| | | | - Kent Garber
- Department of Surgery, University of California, Los Angeles
| | | | - Reinou S Groen
- Department of Obstetrics and Gynecology, Alaska Native Medical Center, Anchorage
| | - Gary Hsin
- Stanford University School of Medicine, Stanford, California
| | | | - Adam L Kushner
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland
| | - Ian Norton
- Emergency Operations and Partnerships, Emergency Operations, World Health Organization, Geneva, Switzerland
| | - Inga Osmers
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Tarek Razek
- Centre for Global Surgery, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | | | - John Troke
- Samaritan's Purse, Boone, North Carolina
| | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, California
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7
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Oosting RM, Wauben LSGL, Madete JK, Groen RS, Dankelman J. Availability, procurement, training, usage, maintenance and complications of electrosurgical units and laparoscopic equipment in 12 African countries. BJS Open 2020; 4:326-331. [PMID: 31984671 PMCID: PMC7092388 DOI: 10.1002/bjs5.50255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/02/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Strategies are needed to increase the availability of surgical equipment in low- and middle-income countries (LMICs). This study was undertaken to explore the current availability, procurement, training, usage, maintenance and complications encountered during use of electrosurgical units (ESUs) and laparoscopic equipment. METHODS A survey was conducted among surgeons attending the annual meeting of the College of Surgeons of East, Central and Southern Africa (COSECSA) in December 2017 and the annual meeting of the Surgical Society of Kenya (SSK) in March 2018. Biomedical equipment technicians (BMETs) were surveyed and maintenance records collected in Kenya between February and March 2018. RESULTS Among 80 participants, there were 59 surgeons from 12 African countries and 21 BMETs from Kenya. Thirty-six maintenance records were collected. ESUs were available for all COSECSA and SSK surgeons, but only 49 per cent (29 of 59) had access to working laparoscopic equipment. Reuse of disposable ESU accessories and difficulties obtaining carbon dioxide were identified. More than three-quarters of surgeons (79 per cent) indicated that maintenance of ESUs was available, but only 59 per cent (16 of 27) confirmed maintenance of laparoscopic equipment at their centre. CONCLUSION Despite the availability of surgical equipment, significant gaps in access to maintenance were apparent in these LMICs, limiting implementation of open and laparoscopic surgery.
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Affiliation(s)
- R M Oosting
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - L S G L Wauben
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.,Innovations in Care Research Centre, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - J K Madete
- Department of Electrical and Electronic Engineering, School of Engineering and Technology, Kenyatta University, Nairobi, Kenya
| | - R S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - J Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Knulst AJ, Gupta S, Groen RS, Maharjan D, Kapendra AS, Dankelman J, Kushner AL. Directions for surgical capacity developments in Nepal: a population-based assessment. Trop Med Int Health 2019; 24:1128-1137. [PMID: 31328362 PMCID: PMC6852409 DOI: 10.1111/tmi.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Lack of access to safe surgery is seen as a major issue that needs to be addressed. The aim of this study was to understand which combinations of factors relate to high occurrences of unmet needs and disability in Nepal, and consequently, how to focus future work to maximise impact in this country. Methods A large population‐based survey was conducted in Nepal in 2014 to evaluate the unmet surgical needs that result in disability. Recorded factors included diseased anatomical areas, disease specifics, disease locations, injury types, reasons for having an unmet need and the types of disability. Results Included in the study were 2695 individuals. The anatomical areas facing the highest disabling unmet surgical need were Head (3.9% of population), Groin/Genitalia (2.2% of population) and Extremities (3.6% of population). Four focus areas could be defined. Increase affordability, availability and acceptability of surgical care to non‐traumatic disabling conditions of (i) the eye, and (ii) extremities, and (iii) to traumatic disabling conditions of extremities and finally (iv) increase acceptability of having surgical care for non‐traumatic conditions in the groin and genital area. For the latter, fear/no trust was the main reason for receiving no surgical care despite the resulting shame. Conclusions This study defined four focus areas that showed the largest unmet needs that resulted in a perceived disability. For those areas, affordability, availability and acceptability of surgical need to be addressed through technical developments, capacity building and raising awareness.
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Affiliation(s)
| | - Shailvi Gupta
- R Adams Cowley Shock Trauma Center, Baltimore, USA.,Surgeons OverSeas, New York, USA
| | - Reinou S Groen
- Alaska Native Medical Center, Anchorage, USA.,Johns Hopkins Hospital, Baltimore, USA
| | - Dipak Maharjan
- INF Green Pastures Hospital & Rehabilitation Center, Pokhara, Nepal
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Varela C, Young S, Mkandawire N, Groen RS, Banza L, Viste A. TRANSPORTATION BARRIERS TO ACCESS HEALTH CARE FOR SURGICAL CONDITIONS IN MALAWI a cross sectional nationwide household survey. BMC Public Health 2019; 19:264. [PMID: 30836995 PMCID: PMC6402149 DOI: 10.1186/s12889-019-6577-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background It is estimated that nearly five billion people worldwide do not have access to safe surgery. This access gap disproportionately affects low-and middle-income countries (LMICs). One of the barriers to healthcare in LMICs is access to transport to a healthcare facility. Both availability and affordability of transport can be issues delaying access to health care. This study aimed to describe the main transportation factors affecting access and delay in reaching a facility for health care in Malawi. Methods This was a multi-stage, clustered, probability sampling with systematic sampling of households for transportation access to general health and surgical care. Malawi has an estimated population of nearly 18 million people, with a total of 48,233 registered settlements spread over 28 administrative districts. 55 settlements per district were randomly selected for data collection, and 2–4 households were selected, depending on the size. Two persons per household were interviewed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used by trained personnel to collect data during the months of July and August 2016. Analysis of data from 1479 households and 2958 interviewees was by univariate and multivariate methods. Results Analysis showed that 90.1% were rural inhabitants, and 40% were farmers. No formal employment was reported for 24.9% persons. Animal drawn carts prevailed as the most common mode of transport from home to the primary health facility - normally a health centre. Travel to secondary and tertiary level health facilities was mostly by public transport, 31.5 and 43.4% respectively. Median travel time from home to a health centre was 1 h, and 2.5 h to a central hospital. Thirty nine percent of male and 59% of female head of households reported lack financial resources to go to a hospital. Conclusion In Malawi, lack of suitable transport, finances and prolonged travel time to a health care centre, all pose barriers to timely access of health care. Improving the availability of transport between rural health centres and district hospitals, and between the district and central hospitals, could help overcome the transportation barriers to health care.
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Affiliation(s)
- Carlos Varela
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi. .,University of Malawi, College of Medicine, Lilongwe, Malawi. .,Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway.
| | - Sven Young
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Nyengo Mkandawire
- Department of Surgery, Queen Elizabeth Central Hospital, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Clinical Medicine and Centre for International Health, University of Bergen, Bergen, Norway.,Department of Research & Development, Haukeland University Hospital, Bergen, Norway
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10
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Zha Y, Stewart B, Lee E, Remick KN, Rothstein DH, Groen RS, Burnham G, Imagawa DK, Kushner AL. Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons. World J Surg 2017; 40:2628-2634. [PMID: 27225996 DOI: 10.1007/s00268-016-3579-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives. METHODS Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs. RESULTS At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care. CONCLUSION Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.
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Affiliation(s)
- Yuanting Zha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,University of California, Irvine School of Medicine, Irvine, CA, USA.
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA.,School of Medical Sciences, Kwame Nkrumah University, Kumasi, Ghana.,Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eugenia Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kyle N Remick
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Deputy, Combat Casualty Care Research Program, Fort Detrick, MD, USA
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Reinou S Groen
- Department of Gynecology & Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David K Imagawa
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Surgery, Columbia University, New York, NY, USA.,Surgeons OverSeas, New York, NY, USA
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11
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Forrester JD, Forrester JA, Kamara TB, Groen RS, Shrestha S, Gupta S, Kyamanywa P, Petroze RT, Kushner AL, Wren SM. Self-reported Determinants of Access to Surgical Care in 3 Developing Countries. JAMA Surg 2016; 151:257-63. [PMID: 26536154 DOI: 10.1001/jamasurg.2015.3431] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Surgical care is recognized as a growing component of global public health. OBJECTIVE To assess self-reported barriers to access of surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool. DESIGN, SETTING, AND PARTICIPANTS Data for this cross-sectional, cluster-based population survey were collected from households in Rwanda (October 2011), Sierra Leone (January 2012), and Nepal (May and June 2014) using the Surgeons OverSeas Assessment of Surgical Need tool. MAIN OUTCOMES AND MEASURES Basic demographic information, cost and mode of transportation to health care facilities, and barriers to access to surgical care of persons dying within the past year were analyzed. RESULTS A total of 4822 households were surveyed in Nepal, Rwanda, and Sierra Leone. Primary health care facilities were commonly reached rapidly by foot (>70%), transportation to secondary facilities differed by country, and public transportation was ubiquitously required for access to a tertiary care facility (46%-82% of respondents). Reasons for not seeking surgical care when needed included no money for health care (Sierra Leone: n = 103; 55%), a person dying before health care could be arranged (all countries: 32%-43%), no health care facility available (Nepal: n = 11; 42%), and a lack of trust in health care (Rwanda: n = 6; 26%). CONCLUSIONS AND RELEVANCE Self-reported determinants of access to surgical care vary widely among Sierra Leone, Rwanda, and Nepal, although commonalities exist. Understanding the epidemiology of barriers to surgical care is essential to effectively provide surgical service as a public health commodity in developing countries.
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Affiliation(s)
| | | | - Thaim B Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone3College of Medicine and Allied Health Science, Freetown, Sierra Leone
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland5Surgeons OverSeas, New York, New York
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Shailvi Gupta
- Surgeons OverSeas, New York, New York7Department of Surgery, University of California-San Francisco, East Bay, Oakland
| | - Patrick Kyamanywa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robin T Petroze
- Department of Surgery, University of Virginia, Charlottesville
| | - Adam L Kushner
- Surgeons OverSeas, New York, New York10Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland11Department of Surgery, Columbia University, New York, New York
| | - Sherry M Wren
- Department of Surgery, Stanford University, Stanford, California
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12
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Gupta S, Groen TA, Stewart BT, Shrestha S, Spiegel DA, Nwomeh BC, Groen RS, Kushner AL. The spatial distribution of injuries in need of surgical intervention in Nepal. Geospat Health 2016; 11:359. [PMID: 27245791 DOI: 10.4081/gh.2016.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 09/24/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R2=0.27). Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.
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Affiliation(s)
- Shailvi Gupta
- University of California, San Francisco East Bay and Surgeons OverSeas, Oakland, CA.
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13
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Liu M, Nagarajan N, Ranjit A, Gupta S, Shrestha S, Kushner AL, Nwomeh BC, Groen RS. Reproductive health care and family planning among women in Nepal. Int J Gynaecol Obstet 2016; 134:58-61. [PMID: 27113417 DOI: 10.1016/j.ijgo.2015.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/03/2015] [Accepted: 03/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe findings from a validated survey examining access to care, contraceptive needs, access to surgical care, menstruation-related healthcare needs, and barriers to receiving reproductive health care in Nepal. METHODS An analysis was undertaken using data obtained through a two-part population-based, cross-sectional, cluster-randomized survey corroborated by a visual physical examination performed nationwide between May 25 and June 12, 2014. Women aged 12-50years were included. The odds of delivering exclusively in a health facility, having a cesarean delivery, and using contraception were modeled using logistic regression. RESULTS Overall, 876 female interviewees were of reproductive age (12-50years). Only 237 (27.1%) women were using contraception. Maternal education was the strongest predictor of delivering exclusively in a healthcare facility (odds ratio [OR] 7.57, 95% confidence interval [CI] 4.48-12.79; P<0.001). The odds of having a cesarean delivery were doubled by urban living (OR 2.20, 95% CI 1.09-4.13; P<0.001). On multivariable analysis, a predictor of using contraception was a history of having given birth (OR 9.61, 95% CI 4.62-20.01; P<0.001). CONCLUSION In Nepal, reproductive healthcare disparities for women are manifold. Education for women appears to be a significant determinant of accessing reproductive health care.
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Affiliation(s)
- Marisa Liu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of Vermont, College of Medicine, Burlington, VT, USA.
| | | | - Anju Ranjit
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA
| | - Shailvi Gupta
- Surgeons OverSeas, New York, NY, USA; University of California San Francisco, East Bay, CA, USA
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College Teaching Hospital, Kathmandu, Nepal
| | - Adam L Kushner
- Surgeons OverSeas, New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas, New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Reinou S Groen
- Surgeons OverSeas, New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
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14
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Ranjit A, Gupta S, Shrestha R, Kushner AL, Nwomeh BC, Groen RS. Awareness and prevalence of cervical cancer screening among women in Nepal. Int J Gynaecol Obstet 2016; 134:37-40. [PMID: 27207110 DOI: 10.1016/j.ijgo.2015.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/31/2015] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate awareness and prevalence of cervical smear testing among women in Nepal. METHODS A secondary analysis of data obtained as part of a nationwide household survey between May 25 and June 14, 2015, was undertaken. Information obtained from women aged 21-65years was included. Multiple regression analyses were performed to identify factors associated with having undergone cervical smear testing. RESULTS A total of 829 women were included. Among 816 women who answered the relevant survey question, 710 (87.0%) had no knowledge of cervical smear tests. Only 39 (4.7%) of the 829 women had ever undergone a cervical smear. In multivariate analysis, having undergone a cervical smear was associated with literacy (adjusted odds ratio [aOR] 3.26, 95% confidence interval [CI] 1.25-8.51; P=0.016) and living in rural areas (aOR 0.48, 95% CI 0.24-0.96; P=0.038). CONCLUSION Nepali women rarely undergo cervical smear screening, with the lowest prevalence recorded among the illiterate and those living in rural areas. To boost screening rates, educational campaigns and rural outreach are needed.
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Affiliation(s)
- Anju Ranjit
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA.
| | - Shailvi Gupta
- Surgeons OverSeas, New York, NY, USA; Department of Surgery, University of California, San Francisco, East Bay, CA, USA
| | - Ritesh Shrestha
- Department of Surgery, Nepal Medical College Teaching Hospital, Kathmandu, Nepal
| | - Adam L Kushner
- Surgeons OverSeas, New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas, New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Reinou S Groen
- Surgeons OverSeas, New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
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15
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Wong EG, Kamara TB, Groen RS, Zogg CK, Zenilman ME, Kushner AL. Prevalence of surgical conditions in individuals aged more than 50 years: a cluster-based household survey in Sierra Leone. World J Surg 2015; 39:55-61. [PMID: 24791948 DOI: 10.1007/s00268-014-2620-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the demographic transition disproportionately affecting developing nations, the healthcare burden associated with the elderly is likely to be compounded by poor baseline surgical capacity in these settings. We sought to assess the prevalence of surgical disease and disability in the elderly population of Sierra Leone to guide future development strategies. METHODS A cluster randomized, cross-sectional household survey was carried out countrywide in Sierra Leone from January 9th to February 3rd 2012. Using a standardized questionnaire, household member demographics, deaths occurring during the previous 12 months, and presence of any current surgical condition were elucidated. A retrospective analysis of individuals aged 50 and over was performed. RESULTS The survey included 1,843 households with a total of 3,645 respondents. Of these, 13.6 % (496/3,645) were aged over 50 years. Of the elderly individuals in our sample, 301 (60.7 %) reported a current surgical condition. Of current surgical disease identified among elderly individuals (n = 530), 349 (65.8 %) described it as disabling, and 223 (42.1 %) sought help from traditional medicine practitioners. Women (odds ratio [OR] 0.60; 95 % confidence interval [CI] 0.40-0.90) and individuals living in urban settings (OR 0.44, 95 % CI 0.26-0.75) were less likely to report a current surgical problem. Of the 230 elderly deaths in the previous year, 83 (36.1 %) reported a surgical condition in the week prior. CONCLUSIONS The unmet burden of surgical disease is prevalent in the elderly in low-resource settings. This patient population is expected to grow significantly in the coming years, and more resources should be allocated to address their surgical needs.
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Affiliation(s)
- Evan G Wong
- Centre for Global Surgery, McGill University Health Centre, 1650 Cedar Avenue, L9 411, Montreal, QC, H3G 1A4, Canada,
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16
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Stewart BT, Groen RS, Kamara TB, Kwon S, Kingham TP, Kushner AL. Rectal bleeding and endoscopy need in Sierra Leone: results of a nationwide, community-based survey. Lancet 2015; 385 Suppl 2:S4. [PMID: 26313088 DOI: 10.1016/s0140-6736(15)60799-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low-income and middle-income countries (LMICs) face a large burden of gastrointestinal diseases that benefit from prompt endoscopic diagnosis and treatment. This study aimed to estimate the prevalence of gross rectal bleeding among adults in Sierra Leone. METHODS A cluster randomised, cross-sectional household survey using the SOSAS tool was undertaken in Sierra Leone. 75 clusters of 25 households with two randomly selected respondents in each were sampled to estimate the prevalence of and disability from rectal bleeding. Barriers to care were also assessed. FINDINGS 3645 individuals responded to the survery, 15 with rectal bleeding. Nine responders (64%) had been bleeding for more than a year. The prevalence of rectal bleeding was 412 per 100 000 people. In view of these findings, an estimated 24 604 individuals with rectal bleeding are in need of evaluation in Sierra Leone. Eight (53%) of the 15 people with rectal bleeding sought care from a traditional healer. If medical care was not sought, the most common reason was absence of financial resources (ten people; 77%), followed by no capable facility availability (two; 15%), and inability to leave work or family for the time needed (one; 8%). Seven (54%) of those with rectal bleeding reported some form of disability, including five (39%) that had bleeding that prevented usual work. INTERPRETATION The high prevalence of rectal bleeding identified in Sierra Leone represents a major unmet health-care need. This study did not examine the cause of bleeding. However, the high prevalence, chronicity, and disability among respondents with bleeding suggest a substantial burden of disease. Additionally, because microscopic haematochezia was not assessed, these data represent a bare-minimum estimate of rectal bleeding in need of evaluation and treatment. In view of the substantial burden of conditions that can be diagnosed, treated, or palliated with timely endoscopic therapy, it is appropriate to consider endoscopy among efforts to develop health system capacity in LMICs. FUNDING Surgeons OverSeas, the Thompson Family Foundation, and the Fogarty International Center.
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Affiliation(s)
| | - Reinou S Groen
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thaim B Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Steve Kwon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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17
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Stewart BT, Prathak J, Gupta S, Shrestha S, Groen RS, Nwomeh BC, Kushner AL, McIntyre T. An estimate of hernia prevalence in Nepal from a countrywide community survey. Lancet 2015; 385 Suppl 2:S6. [PMID: 26313108 DOI: 10.1016/s0140-6736(15)60801-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Herniorrhaphy is one of the most frequently performed general surgical operations worldwide; however, most low-income and middle-income countries (LMICs) are unable to provide this essential surgery resulting in substantial morbidity and mortality. This study aimed to estimate the prevalence of, barriers to care for, and disability from untreated hernias in Nepal. METHODS A cluster randomised, cross-sectional household survey was performed in Nepal using the validated Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Sample size was based on a pilot study that reported a 5% prevalence of unmet surgical need. 15 clusters consisting of 30 households each were sampled proportional to population. In each, two randomly selected family members underwent a verbal head-to-toe physical examination and answered questions about barriers to care and disability. FINDINGS The survey sampled 1350 households, totalling 2695 individuals (97% response rate). 1434 (53%) of responders were men and 1·5% (95% CI 1·8-4·0) had a mass or swelling in the groin at time of survey. The age-standardised rate for inguinal hernias in men ranged from 1144 per 100 000 persons between age 5 and 49 years and 2941 per 100 000 persons aged 50 years and older. 29 respondents were not able to have surgery due to lack of surgical services (nine; 31%), fear or mistrust of the surgical system (nine; 31%), and inability to afford care (six; 21%). 10 respondents (20%) were unable to work as previous or perform self-care due to their hernia. INTERPRETATION Despite the lower than expected prevalence of inguinal hernias, more than 300 000 people in Nepal are currently in need of herniorrhaphy. In view that essential surgery is a necessary component in health systems, the prevalence of inguinal hernias and the cost-effectiveness of herniorrhaphy, this disease is an important target for LMICs planning surgical capacity improvements. FUNDING Surgeons OverSeas, Association for Academic Surgery, and the Fogarty International Center.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington DC, USA.
| | | | - Shailvi Gupta
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas McIntyre
- Program for Surgery and Public Health, Kings County Hospital Center, SUNY Downstate Medical School, Brooklyn, NY, USA
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Gupta S, Groen RS, Kyamanywa P, Ameh EA, Labib M, Clarke DL, Donkor P, Derbew M, Sani R, Kamara TB, Shrestha S, Nwomeh BC, Wren SM, Price RR, Kushner AL. Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countries. Lancet 2015; 385 Suppl 2:S1. [PMID: 26313055 DOI: 10.1016/s0140-6736(15)60796-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical care needs in low-resource countries are increasingly recognised as an important aspect of global health, yet data for the size of the problem are insufficient. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a population-based cluster survey previously used in Nepal, Rwanda, and Sierra Leone. METHODS Using previously published SOSAS data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of overall prevalence of surgically treatable conditions was estimated and the number of deaths that could have been avoided by providing access to surgical care was calculated for the broader community of low-resource countries. Such conditions included, but were not limited to, injuries (road traffic incidents, falls, burns, and gunshot or stab wounds), masses (solid or soft, reducible), deformities (congenital or acquired), abdominal distention, and obstructed delivery. Population and health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with a per capita health expenditure of US$100 or less annually. The overall prevalence estimate from the previously published SOSAS data was extrapolated to each low-resource country. Using crude death rates for each country and the calculated proportion of avoidable deaths, a total number of deaths possibly averted in the previous year with access to appropriate surgical care was calculated. FINDINGS The overall prevalence of surgically treatable conditions was 11·16% (95% CI 11·15-11·17) and 25·6% (95% CI 25·4-25·7) of deaths were potentially avoidable by providing access to surgical care. Using these percentages for the 48 low-resource countries, an estimated 288·2 million people are living with a surgically treatable condition and 5·6 million deaths could be averted annually by the provision of surgical care. In the Nepal SOSAS study, the observed agreement between self-reported verbal responses and visual physical examination findings was 94·6%. Such high correlation helps to validate the SOSAS tool. INTERPRETATION Hundreds of millions of people with surgically treatable conditions live in low-resource countries, and about 25% of the mortality annually could be avoided with better access to surgical care. Strengthening surgical care must be considered when strengthening health systems and in setting future sustainable development goals. FUNDING None.
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Affiliation(s)
- Shailvi Gupta
- University of California San Francisco, East Bay, Surgeons OverSeas, Oakland, CA, USA.
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Department of Obstetrics and Gynecology, Surgeons OverSeas, Baltimore, MD, USA
| | - Patrick Kyamanywa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Mohamed Labib
- Department of Surgery, University of Namibia, Namibia
| | - Damian L Clarke
- Department of Surgery, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Peter Donkor
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa
| | - Rachid Sani
- Department of General and Digestive Surgery, National Hospital of Niamey, Niamey, Niger
| | - Thaim B Kamara
- Department of Surgery, Connaught Hospital, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Benedict C Nwomeh
- Surgeons OverSeas, Nationwide Children's Hospital, Ohio State University, OH, USA
| | | | - Raymond R Price
- Intermountain Healthcare, Department of Surgery, Center for Global Surgery, University of Utah, Salt Lake City, UT, USA
| | - Adam L Kushner
- Surgeons OverSeas, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of Surgery, Columbia University, Baltimore, MD, USA
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Gupta S, Wren SM, Kamara TB, Shrestha S, Kyamanywa P, Wong EG, Groen RS, Nwomeh BC, Kushner AL, Price RR. Injury assessment in three low-resource settings: a reference for worldwide estimates. Lancet 2015; 385 Suppl 2:S2. [PMID: 26313066 DOI: 10.1016/s0140-6736(15)60797-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trauma has become a worldwide pandemic. Without dedicated public health interventions, fatal injuries will rise 40% and become the 4th leading cause of death by 2030, with the burden highest in low-income and middle-income countries (LMICs). The aim of this study was to estimate the prevalence of traumatic injuries and injury-related deaths in low-resource countries worldwide, using population-based data from the Surgeons OverSeas Assessment of Surgical Need (SOSAS), a validated survey tool. METHODS Using data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of injury prevalence and deaths due to injury was calculated and extrapolated to low-resource countries worldwide. Injuries were defined as wounds from road traffic injuries (bus, car, truck, pedestrian, and bicycle), gunshot or stab or slash wounds, falls, work or home incidents, and burns. The Nepal study included a visual physical examination that confirmed the validity of the self-reported data. Population and annual health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with an annual per capita health expenditure of US$100 or less. FINDINGS The overall prevalence of lifetime injury for these three countries was 18·03% (95% CI 18·02-18·04); 11·64% (95% CI 11·53-11·75) of deaths annually were due to injury. An estimated prevalence of lifetime injuries for the total population in 48 low-resource countries is 465·7 million people; about 2·6 million fatal injuries occur in these countries annually. INTERPRETATION The limitations of this observational study with self-reported data include possible recall and desirability bias. About 466 million people at a community level (18%) sustain at least one injury during their lifetime and 2·6 million people die annually from trauma in the world's poorest countries. Trauma care capacity should be considered a global health priority; the importance of integrating a coordinated trauma system into any health system should not be underestimated. FUNDING None.
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Affiliation(s)
- Shailvi Gupta
- University of California, San Francisco East Bay, Oakland, CA, USA.
| | | | | | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Patrick Kyamanywa
- College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Evan G Wong
- McGill University Centre for Global Surgery, Montreal, QC, Canada
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Department of Obstetrics and Gynecology, Surgeons OverSeas, Baltimore, MD, USA, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas, Nationwide Children's Hospital, Ohio State University, OH, USA
| | - Adam L Kushner
- Surgeons OverSeas, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of Surgery, Columbia University, Baltimore, MD, USA
| | - Raymond R Price
- Intermountain Healthcare, Department of Surgery, Center for Global Surgery, University of Utah, Salt Lake City, UT, USA
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Gupta S, Shrestha S, Ranjit A, Nagarajan N, Groen RS, Kushner AL, Nwomeh BC. Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal. Br J Surg 2015; 102:700-7. [PMID: 25809125 DOI: 10.1002/bjs.9807] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/26/2015] [Accepted: 02/17/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND To determine a true denominator of worldwide surgical need, it is imperative to include estimations at a population-based level, to capture those individuals unable to access surgical care. This study was designed to validate the Surgeons OverSeas Assessment of Surgical need (SOSAS) tool with the addition of a visual physical examination, and describe the prevalence of surgical conditions, deaths possibly averted with access to surgical care, and the number of surgical procedures performed annually, in Nepal. METHODS The SOSAS tool, developed to measure the prevalence of surgical conditions at a population level and used in two African countries, was employed. Fifteen of the 75 districts of Nepal were chosen proportional to population. Responses were recorded for the head of the household for demographic information and recalled deaths, and two randomly selected household members underwent a verbal head-to-toe interview for surgical conditions and a visual physical examination by a trained physician. RESULTS A total of 1350 households were surveyed (2695 respondents). Observed agreement between the verbal response and physical examination findings was 94·6 per cent. Some 10·0 (95 per cent c.i. 8·9 to 11·2) per cent of respondents had a current condition requiring surgical care and 23 per cent of deaths may have been averted with proper access to surgical care. An estimated 291·8 major operations per 100 000 population are performed annually in Nepal. CONCLUSION The visual physical examination component validated the SOSAS tool, and justified the estimates of previous studies in Sierra Leone and Rwanda. These data provide insights into the health needs of Nepal and provide evidence to develop surgical programmes, assist with monitoring and evaluation, and help with advocacy for increased resources in Nepal.
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Affiliation(s)
- S Gupta
- Department of Surgery, University of California San Francisco East Bay, Oakland, California, USA; Surgeons OverSeas, New York, USA
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Groen RS, Trelles M, Caluwaerts S, Papillon-Smith J, Noor S, Qudsia B, Ndelema B, Kondo KM, Wong EG, Patel HD, Kushner AL. A cross-sectional study of indications for cesarean deliveries in Médecins Sans Frontières facilities across 17 countries. Int J Gynaecol Obstet 2015; 129:231-5. [DOI: 10.1016/j.ijgo.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/14/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Groen RS, Gershenson DM, Fader AN. Updates and emerging therapies for rare epithelial ovarian cancers: one size no longer fits all. Gynecol Oncol 2015; 136:373-83. [PMID: 25481800 DOI: 10.1016/j.ygyno.2014.11.078] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 02/03/2023]
Abstract
Epithelial ovarian carcinoma consists of not one, but several, entities. A number of subtypes exist, including high-grade and low-grade serous carcinomas, clear cell, endometrioid carcinoma and mucinous carcinoma. Historically, women with epithelial ovarian cancer have been treated similarly and "lumped" in the same cooperative group treatment trials, irrespective of their tumor subtype. Recently, however, differences in epidemiology, tumor biology, tumor marker expression and treatment responses have been elucidated among the histologic subtypes, with a clear distinction emerging between the Type I, lower grade tumors and Type 2, higher grade epithelial malignancies. A mounting body of research demonstrates that a "one-size-fits-all" treatment approach to epithelial ovarian tumors is no longer relevant, especially for the Type I subtypes. Indeed, with the exception of high-grade serous carcinoma, most other epithelial subtypes exhibit some degree of chemotherapy resistance, rendering treatment problematic, especially in the setting of advanced disease. This review summarizes the genetic, molecular, and clinical differences of the more rare, but clinically important, Type I epithelial ovarian tumors. Additionally, a critical appraisal of both historical and contemporary treatment approaches and the rationale for targeted therapies are emphasized.
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Affiliation(s)
- Reinou S Groen
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
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Gupta S, Ghimire P, Shrestha S, Ranjit A, Kingham TP, Groen RS, Kushner AL, Nwomeh BC. Untreated breast masses: A cross-sectional countrywide survey of Nepal. Surgery 2015; 158:55-7. [PMID: 25633734 DOI: 10.1016/j.surg.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Shailvi Gupta
- Department of Surgery, University of California San Francisco East Bay; Surgeons OverSeas, Oakland, CA.
| | | | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Anju Ranjit
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center; Surgeons OverSeas, New York, NY
| | - Reinou S Groen
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine; Surgeons OverSeas, Baltimore, MD
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Surgeons OverSeas, Baltimore, MD
| | - Benedict C Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital; Surgeons OverSeas, Columbus, OH
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Grover S, Xu MJ, Yeager A, Rosman L, Groen RS, Chackungal S, Rodin D, Mangaali M, Nurkic S, Fernandes A, Lin LL, Thomas G, Tergas AI. A systematic review of radiotherapy capacity in low- and middle-income countries. Front Oncol 2015; 4:380. [PMID: 25657930 PMCID: PMC4302829 DOI: 10.3389/fonc.2014.00380] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC. Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health, and the Latin American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013. Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases). The main concern with the review of RT resources in Eastern Europe was the lack of data. Conclusion: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the countries’ economic status. The challenges to delivering radiation in the discussed regions are multidimensional and include lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing RT and affordability of care remains a large problem.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Melody J Xu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Alyssa Yeager
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lori Rosman
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Smita Chackungal
- Department of Surgery, University of Western Ontario , London, ON , Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Margaret Mangaali
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Sommer Nurkic
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Annemarie Fernandes
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lilie L Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Gillian Thomas
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons , New York, NY , USA
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Elliott IS, Groen RS, Kamara TB, Ertl A, Cassidy LD, Kushner AL, Gosselin RA. The burden of musculoskeletal disease in Sierra Leone. Clin Orthop Relat Res 2015; 473:380-9. [PMID: 25344406 PMCID: PMC4390972 DOI: 10.1007/s11999-014-4017-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal disease is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in developing countries are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure the incidence and prevalence of surgically treatable conditions, including musculoskeletal conditions, in patients in low- and middle-income countries, and was administered in the West African nation of Sierra Leone in 2012. PURPOSE We attempted to quantify the burden of potentially treatable musculoskeletal conditions in patients in Sierra Leone. METHODS A cross-sectional two-stage cluster-based survey was performed in Sierra Leone using the SOSAS. Two individuals from each randomly selected household underwent a verbal head to toe examination. The musculoskeletal-related questions from the SOSAS survey in Sierra Leone were analyzed to determine the prevalence of musculoskeletal problems in the study population. Prevalence is reported as the number of respondents with a musculoskeletal problem now and number of respondents with a musculoskeletal problem during the past year. Respondents had "no need" for care, they "received care", or they faced a barrier that prevented them from receiving care. RESULTS One thousand eight hundred seventy-five households were targeted, with 1843 undergoing the survey, which yielded 3645 individual respondents. Of the individual respondents, 462 (n=3645; 12.6% of total; 95% CI, 12%-13%) had a traumatic musculoskeletal problem during the past year, and 236 (n=3645; 6% of total; 95% CI, 5%-7%) respondents had a musculoskeletal problem of nontraumatic etiology. Of respondents with either a traumatic or nontraumatic musculoskeletal problem, 359 (n=562; 63.9% of total; 95% CI, 59.5-68.3%) needed care but were unable to receive it with the major barrier reported as financial. CONCLUSION Resource allocation decisions in global health are made based on burden of disease data in low- and middle-income countries. The data provided here for Sierra Leone may offer some generalizable insight into the scope of the burden of musculoskeletal disease for low- and middle-income countries, especially in Sub-Saharan Africa, and provide concrete evidence that musculoskeletal health should be included in the global health discussion. However, there may be important differences across countries in this region, and further study to elucidate these differences seems critical given the large burden of disease and the limited resources available in these regions to manage it.
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Affiliation(s)
- Iain S. Elliott
- University of Florida, Gainesville, FL USA ,Institute for Global Orthopaedics and Traumatology, San Francisco General Hospital, University of California at San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA
| | - Reinou S. Groen
- Surgeons OverSeas (SOS), New York, NY USA ,Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD USA
| | - Thaim B. Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Allison Ertl
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI USA
| | - Laura D. Cassidy
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI USA
| | - Adam L. Kushner
- Surgeons OverSeas (SOS), New York, NY USA ,Department of Surgery, Columbia University, New York, NY USA ,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Richard A. Gosselin
- Institute for Global Orthopaedics and Traumatology, San Francisco General Hospital, University of California at San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA ,School of Public Health, University of California, Berkeley, Berkeley, CA USA
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Stewart BT, Pathak J, Gupta S, Shrestha S, Groen RS, Nwomeh BC, Kushner AL, McIntyre T. An estimate of hernia prevalence in Nepal from a countrywide community survey. Int J Surg 2014; 13:111-114. [PMID: 25500564 DOI: 10.1016/j.ijsu.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Herniorrhaphy is one of the most frequently performed general surgical operations worldwide. However, most low- and middle-income countries (LMICs) are unable to provide this essential surgery to the general public, resulting in considerable morbidity and mortality. This study aimed to estimate the prevalence, barriers to care and disability of untreated hernias in Nepal. METHODS Nepal is a low-income country in South Asia with rugged terrain, infrastructure deficiencies and a severely under-resourced healthcare system resulting in substantial unmet surgical need. A cluster randomized, cross-sectional household survey was performed using the validated Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Fifteen randomized clusters consisting of 30 households with two randomly selected respondents each were sampled to estimate surgical need. The prevalence of and disability from groin hernias and barriers to herniorrhaphy were assessed. RESULTS The survey sampled 1350 households, totaling 2695 individuals (97% response rate). There were 1434 males (53%) with 1.5% having a mass or swelling in the groin at time of survey (95% CI 1.8-4.0). The age-standardized rate for inguinal hernias in men ranged from 1144 per 100,000 persons between age 5 and 49 years and 2941 per 100,000 persons age≥50 years. Extrapolating nationally, there are nearly 310,000 individuals with groin masses and 66,000 males with soft/reducible groin masses in need of evaluation in Nepal. Twenty-nine respondents were not able to have surgery due to lack of surgical services (31%), fear or mistrust of the surgical system (31%) and inability to afford care (21%). Twenty percent were unable to work as previous or perform self-care due to their hernia. CONCLUSIONS Despite the lower than expected prevalence of inguinal hernias, hundreds of thousands of people in Nepal are currently in need of surgical evaluation. Given that essential surgery is a necessary component in health systems, the prevalence of inguinal hernias and the cost-effectiveness of herniorrhaphy, this disease is an important target for LMICs planning surgical capacity improvements.
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Affiliation(s)
| | | | - Shailvi Gupta
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA
| | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Kathmandu, Nepal
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Benedict C Nwomeh
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Thomas McIntyre
- Program for Surgery and Public Health, Kings County Hospital Center, SUNY Downstate Medical School, Brooklyn, NY, USA
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Zogg CK, Kamara TB, Groen RS, Mungo B, Kushner AL, Molena D. Prevalence of thoracic surgical care need in a developing country: results of a cluster-randomized, cross-sectional nationwide survey. Int J Surg 2014; 13:1-7. [PMID: 25447608 DOI: 10.1016/j.ijsu.2014.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Developing countries without established surgical capacity face heightened morbidity and mortality from poorly understood, untreated thoracic surgical impairments. This study sought to estimate the prevalence of thoracic surgical need in a low-income country and consider contributing factors involved. METHODS Cluster-randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool in Sierra Leone from January 9-February 3, 2012. RESULTS Data were collected and analyzed from 3645 respondents (response rate 98.3%). 273 (7.5%) reported ≥1 chest (including heart, lungs, and mediastinum) or breast surgical problem during their lifetime; 268 (7.4%) reported ≥1 back complaint. Multiple problems could be reported, resulting in a total of 277 chest/breast and 268 back complaints. The majority (184/545) were related to acquired deformities. Most occurred ≥12 months ago (364/545) and continued to impact the participant at the time of the interview (339/545). 322/545 sought care; however, 40% (130/322) did not receive care, predominately due to an inability to pay. Adjusted logistic regression found that chest/breast problems were more common among farm workers, older participants, and individuals with minimal education, while back problems were more common in the same groups and males. CONCLUSIONS The study provides data on the prevalence of thoracic surgical conditions and factors affecting prevalence in one of the world's poorest countries. The results speak to the need for further work to enhance health systems strengthening while offering the opportunity for future training and research in resource-limited settings--an area of thoracic surgery that is not well understood.
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Affiliation(s)
- Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School & Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA; Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | | | - Reinou S Groen
- Surgeons OverSeas (SOS), 505 East 5th Street, Suite 3E, New York, NY 10009, USA; Department of Gynecology & Obstetrics, The Johns Hopkins Hospital, 1650 Orleans Street, Baltimore, MD 21287, USA
| | - Benedetto Mungo
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, 1650 Orleans Street, Baltimore, MD 21287, USA
| | - Adam L Kushner
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Surgeons OverSeas (SOS), 505 East 5th Street, Suite 3E, New York, NY 10009, USA; Department of Surgery, Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, 1650 Orleans Street, Baltimore, MD 21287, USA
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Gupta S, Ranjit A, Shrestha R, Wong EG, Robinson WC, Shrestha S, Nwomeh BC, Groen RS, Kushner AL. Surgical Needs of Nepal: Pilot Study of Population Based Survey in Pokhara, Nepal. World J Surg 2014; 38:3041-6. [DOI: 10.1007/s00268-014-2753-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ntirenganya F, Petroze RT, Kamara TB, Groen RS, Kushner AL, Kyamanywa P, Calland JF, Kingham TP. Prevalence of breast masses and barriers to care: results from a population-based survey in Rwanda and Sierra Leone. J Surg Oncol 2014; 110:903-6. [PMID: 25088235 DOI: 10.1002/jso.23726] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/18/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Breast cancer incidence may be increasing in low- and middle-income countries (LMIC). This study estimates the prevalence of breast masses in Rwanda (RW) and Sierra Leone (SL) and identifies barriers to care for women with breast masses. only. METHODS Data were collected from households in RW and SL using Surgeons Overseas Assessment of Surgical Need (SOSAS), a cross-sectional, randomized, cluster-based population survey designed to identify surgical conditions. Data regarding breast masses and barriers to care in women with breast masses were analyzed. RESULTS 3,469 households (1,626 RW; 1,843 SL) were surveyed and 6,820 persons (3,175 RW; 3,645 SL) interviewed. Breast mass prevalence was 3.3% (SL) and 4.6% (RW). Overall, 93.8% of masses were in women, with 49.1% (SL) and 86.1% (RW) in women >30 years. 73.7% (SL) and 92.4% (RW) of women reported no disability; this was their primary reason for not seeking medical attention. Overall, 36.8% of women who reported masses consulted traditional healers only. CONCLUSIONS For women in RW and SL, minimal education, poverty, and reliance on traditional healers are barriers to medical care for breast masses. Public health programs to increase awareness and decrease barriers are necessary to lower breast cancer mortality rates in low- and middle-income countries (LMIC).
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Affiliation(s)
- Faustin Ntirenganya
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda; Faculty of Medicine, National University of Rwanda, Rwanda
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Van Buren NC, Groen RS, Kushner AL, Samai M, Kamara TB, Ying J, Meier JD. Untreated Head and Neck Surgical Disease in Sierra Leone. Otolaryngol Head Neck Surg 2014; 151:638-45. [DOI: 10.1177/0194599814542587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Demonstrate how the Surgeons OverSeas Assessment of Surgical Need (SOSAS) can be used to determine the burden of head and neck (H&N) surgical disease in developing countries and identify reasons for untreated disease. Study Design Cluster randomized, cross-sectional, countrywide survey. Setting Sierra Leone. Subjects and Methods The survey was administered to 75 of 9671 enumeration areas in Sierra Leone between January 9 and February 3, 2012, with 25 households in each cluster randomly selected for the survey. A household representative and 2 randomly selected household members were interviewed. Need for surgical care was based on participants’ responses to whether they had an H&N condition that they believed needed surgical care. Results Of 1875 households, data were analyzed for 1843 (98%), with 3645 total respondents. Seven hundred and one H&N surgical conditions were reported as occurring during the lifetime of the 3645 respondents (19.2%).The current prevalence of H&N conditions in need of a surgical consultation was 11.8%. No money (60.1%) was the most common reason respondents reported for not receiving medical care. A bivariate analysis demonstrated that age, village type, education, and type of condition may be predictors for seeking health care and/or receiving surgical care. Conclusions These results show limited access for patients to be evaluated for a potential H&N surgical condition in Sierra Leone. The true incidence of untreated surgical disease is unknown as most respondents were not evaluated by a surgeon. This survey could be used in other countries as health care professionals assess surgical needs throughout the world.
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Affiliation(s)
- Nicholas C. Van Buren
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reinou S. Groen
- Surgeon OverSeas, New York, New York, USA
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Adam L. Kushner
- Surgeon OverSeas, New York, New York, USA
- Department of Surgery, Columbia University, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohamed Samai
- College of Medicine and Allied Health Science, Freetown, Sierra Leone
| | - Thaim B. Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Jian Ying
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Petroze RT, Calland JF, Niyonkuru F, Groen RS, Kyamanywa P, Li Y, Guterbock TM, Rodgers BM, Rasmussen SK. Estimating pediatric surgical need in developing countries: a household survey in Rwanda. J Pediatr Surg 2014; 49:1092-8. [PMID: 24952795 DOI: 10.1016/j.jpedsurg.2014.01.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 01/25/2014] [Accepted: 01/28/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Surgical services for children are often absent in resource-limited settings. Identifying the prevalence of surgical disease at the community level is important for developing evidence-based pediatric surgical services and training. We hypothesize that the untreated surgical conditions in the pediatric population are largely uncharacterized and that such burden is significant and poorly understood. Furthermore, no such data exist at the population level to describe this population. METHODS We conducted a nationwide cross-sectional cluster-based population survey to estimate the magnitude of surgical disease in Rwanda. Conducted as a verbal questionnaire, questions included representative congenital, acquired, malignant and injury-related conditions. Pediatric responses were analyzed using descriptive statistics and univariate analysis. RESULTS A total of 1626 households (3175 individuals) were sampled with a 99% response rate; 51.1% of all individuals surveyed were younger than age 18. An estimated 50.5% of the total current surgical need occurs in children. Of all Rwandan children, 6.3% (95% CI 5.4%-7.4%), an estimated 341,164 individuals, were identified to have a potentially treatable surgical condition at the time of the interview. The geographic distribution of surgical conditions significantly differed between adults and children (p<0.001). CONCLUSIONS The results emphasize the magnitude of the pediatric surgery need as well as the need for improved education and resources. This may be useful in developing a collaborative local training program.
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Affiliation(s)
- Robin T Petroze
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA; Faculty of Medicine, University of Rwanda, Butare, Rwanda.
| | - J Forrest Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA
| | | | - Yue Li
- Center for Survey Research & Department of Statistics, University of Virginia, Charlottesville, VA, USA
| | - Thomas M Guterbock
- Center for Survey Research & Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Bradley M Rodgers
- Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sara K Rasmussen
- Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Petroze RT, Joharifard S, Groen RS, Niyonkuru F, Ntaganda E, Kushner AL, Guterbock TM, Kyamanywa P, Calland JF. Injury, Disability and Access to Care in Rwanda: Results of a Nationwide Cross-Sectional Population Study. World J Surg 2014; 39:62-9. [DOI: 10.1007/s00268-014-2544-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong EG, Groen RS, Kamara TB, Stewart KA, Cassidy LD, Samai M, Kushner AL, Wren SM. Burns in Sierra Leone: a population-based assessment. Burns 2014; 40:1748-53. [PMID: 24767716 DOI: 10.1016/j.burns.2014.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/08/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Burns remain disproportionately prevalent in developing countries. This study aims to describe the epidemiology of burns in Sierra Leone to serve as a baseline for future programs. METHODS A cluster randomized, cross-sectional, countrywide survey was conducted in 2012 in Sierra Leone. With a standardized questionnaire demographics and deaths during the previous 12 months of household members were assessed with the household representative. Thereafter, 2 randomly selected household members were interviewed, elucidating whether participants had ever had a burn in six body regions and determining burn mechanisms and patterns of health care seeking behavior. RESULTS This study included 1843 households and 3645 individuals. 3.98% (145/3645) of individuals reported at least one burn-injury. The highest proportions of burns were reported in the age groups 0-4 years old (23/426, 5.4%) and 5-14 years old (37/887, 4.17%). The majority of burns (129/145, 89.0%) were caused by a hot liquid/object and the upper, extremities were the most commonly burned body regions, with 36% (53/145) of cases. 21% (30/145) of individuals with burns sought care from a traditional healer. CONCLUSIONS Burns are highly prevalent in Sierra Leone. Further research and resources should be allocated to the care and prevention of thermal injuries.
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Affiliation(s)
- Evan G Wong
- Centre for Global Surgery, McGill University Health Centre, 1650 Cedar Avenue, L9 411, Montreal, QC, Canada H3G 1A4; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA.
| | - Reinou S Groen
- Surgeons OverSeas (SOS), New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thaim B Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; College of Medicine and Allied Health Science (COMAHS), Freetown, Sierra Leone
| | - Kerry-Ann Stewart
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Laura D Cassidy
- Institute for Health and Society, and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed Samai
- Institute for Health and Society, and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Patel HD, Kamara TB, Kushner AL, Groen RS, Allaf ME. Gross hematuria and urinary retention among men from a nationally representative survey in Sierra Leone. Urology 2014; 83:1273-8. [PMID: 24726148 DOI: 10.1016/j.urology.2014.01.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the prevalence of gross hematuria and urinary retention among men in Sierra Leone and report on barriers to care and associated disability. Gross hematuria and urinary retention are classic urologic complaints that require medical attention for significant underlying pathology, but their burden has not been quantified in a developing country. METHODS A cluster randomized, cross-sectional household survey was administered in Sierra Leone using the Surgeons OverSeas Assessment of Surgical need tool as a verbal head-to-toe examination. A total of 2 respondents in each of 25 households in 75 clusters were surveyed to assess surgical needs. Data on questions related to blood from the penis and the inability to urinate for men>12 years were included in the present analysis to determine the period and point prevalence of hematuria and urinary retention. RESULTS From 3645 total respondents, 1054 (28.9%) were men>12 years included in the analysis. Period and point prevalence of gross hematuria were 21.8 per 1000 (95% confidence interval [CI] 13.0-30.7) and 12.3 per 1000 (95% CI 5.7-19.0), respectively, and for urinary retention, they were 19.9 per 1000 (95% CI 11.5-28.4) and 4.7 per 1000 (95% CI 0.5-8.9), respectively. Lack of financial resources was the major barrier to care. Disability assessment showed 19.1% were not able to work as a result of urinary retention, and 34.8% felt ashamed of their gross hematuria. CONCLUSION The results provide a prevalence estimate of gross hematuria and urinary retention for men in Sierra Leone. Accessible medical and surgical care will be critical for early intervention and management.
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Affiliation(s)
- Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Thaim B Kamara
- College of Medicine and Allied Health Science, Freetown, Sierra Leone; Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; University of Sierra Leone, Freetown, Sierra Leone
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY; Surgeons OverSeas (SOS), New York, NY
| | - Reinou S Groen
- Surgeons OverSeas (SOS), New York, NY; Department of International Health, Royal Tropical Institute, Amsterdam, NL, The Netherlands; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
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Patel HD, Kamara TB, Kushner AL, Groen RS. Estimating the prevalence of urinary and fecal incontinence in a nationally representative survey in Sierra Leone. Int J Gynaecol Obstet 2014; 126:175-6. [PMID: 24792404 DOI: 10.1016/j.ijgo.2014.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/12/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thaim B Kamara
- College of Medicine and Allied Health Science, Freetown, Sierra Leone; Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; University of Sierra Leone, Freetown, Sierra Leone
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas, New York, NY, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Reinou S Groen
- Surgeons OverSeas, New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
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Hughes CD, McClain CD, Hagander L, Pierre JH, Groen RS, Kushner AL, Meara JG. Ratio of cesarean deliveries to total operations and surgeon nationality are potential proxies for surgical capacity in central Haiti. World J Surg 2014; 37:1526-9. [PMID: 22986630 DOI: 10.1007/s00268-012-1794-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The World Health Organization has a standardized tool to assess surgical capacity in low- and middle-income countries (LMICs), but it is often resource- and time-intensive. There currently exists no simple, evidence-based measure of surgical capacity in these settings. The proportion of cesarean deliveries in regard to the total operations (C/O ratio) has been suggested as a way to assess quickly the capacity for emergency and essential surgery in LMICs. This ratio has been estimated to be between 23.3 and 41.5 % in LMICs, but the tool's utility has not been replicated. METHODS We reviewed operative logbooks for the Partners In Health/Zanmi Lasante hospital in Cange, Haiti. We recorded data on all consecutive surgical patients from July 2008 to 2010 and calculated the C/O ratio by dividing the number of cesarean deliveries by the total number of operations performed. We also analyzed surgical data by surgeon nationality to provide additional information about local surgical capacity. RESULTS A total of 3,641 operations were performed between 2008 and 2010. The C/O ratio decreased significantly between 2008-2009 and 2009-2010 (13.4 vs. 10.7 %, p = 0.001) as the surgical volume and resources increased. Nationality analysis demonstrated that Haitian surgeons were able to provide a spectrum of general and specialist surgical care. CONCLUSIONS In its inherent relation to essential surgical procedures and to the overall rate of cesarean deliveries in the region, the C/O ratio can provide an accessible assessment of regional surgical resources. In Haiti, the change in the C/O ratio demonstrated a relative increase in surgical capacity from 2008 to 2010. An additional analysis of surgeon nationality ensured that C/O ratio estimates more accurately reflect local practitioner activity, but deficiencies in the regional capacity to address the local burden of surgical disease may still exist.
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Affiliation(s)
- Christopher D Hughes
- Department of Plastic and Oral Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA.
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Groen RS, Samai M, Petroze RT, Kamara TB, Cassidy LD, Joharifard S, Yambasu S, Nwomeh BC, Kushner AL. Household survey in Sierra Leone reveals high prevalence of surgical conditions in children. World J Surg 2014; 37:1220-6. [PMID: 23529099 DOI: 10.1007/s00268-013-1996-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although great efforts are being undertaken to reduce child morbidity and mortality globally, there is limited knowledge about the need for pediatric surgical care. Some data on surgical need is available from hospital registries, but it is difficult to interpret for countries with limited surgical capacity. METHODS A cross-sectional two-stage cluster-based sample survey was undertaken in Sierra Leone, using the Surgeons OverSeas Assessment of Surgical Need tool. Data were collected and analyzed on numbers of children needing surgical care and pediatric deaths that may have been averted if surgical care had been available. RESULTS A total of 1,583 children out of 3,645 individuals (43.3 %) were interviewed. Most (64.0 %, n = 1,013) participants lived in rural areas. At the time of interview, 279 (17.6; 95 % confidence interval (95 % CI): 15.7-19.5 %) had a possible surgical condition in need of a consultation. Children in the northern and eastern provinces of Sierra Leone were much more likely to report a surgical problem than those in the urban-west. CONCLUSIONS There is a high need for surgical care in the pediatric population of Sierra Leone. While additional resources should be allocated to address that need, more research is needed. Ideally, questions on surgically treatable conditions should be added to the frequently performed health care surveys on the pediatric population.
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Affiliation(s)
- Reinou S Groen
- Surgeons OverSeas (SOS), 225 E. 6th Street, Suite 7F, New York, NY 10003, USA.
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Groen RS, Sriram VM, Kamara TB, Kushner AL, Blok L. Individual and community perceptions of surgical care in Sierra Leone. Trop Med Int Health 2013; 19:107-16. [DOI: 10.1111/tmi.12215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Reinou S. Groen
- Department of Gynecology and Obstetrics; Johns Hopkins Hospital; Baltimore MD USA
- Surgeons OverSeas; New York NY USA
| | - Veena M. Sriram
- Department of International Health; Bloomberg School of Public Health; Johns Hopkins University; Baltimore MD USA
| | - Thaim B. Kamara
- Department of Surgery; Connaught Hospital; Freetown Sierra Leone
| | - Adam L. Kushner
- Surgeons OverSeas; New York NY USA
- Department of International Health; Bloomberg School of Public Health; Johns Hopkins University; Baltimore MD USA
- Department of Surgery; Columbia University; New York NY USA
| | - Lucie Blok
- Royal Tropical Institute; Amsterdam The Netherlands
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Markin A, Barbero R, Leow JJ, Groen RS, Skow EJ, Apelgren KN, Kushner AL, Nwomeh BC. A quantitative analysis of surgical capacity in Santa Cruz, Bolivia. J Surg Res 2013; 185:190-7. [DOI: 10.1016/j.jss.2013.05.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/17/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
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Stewart KAA, Groen RS, Kamara TB, Farahzad MM, Samai M, Cassidy LD, Kushner AL, Wren SM. Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone. JAMA Surg 2013; 148:463-9. [PMID: 23325317 PMCID: PMC4064369 DOI: 10.1001/jamasurg.2013.1341] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To use a nationwide household survey tool to provide an estimate of injury prevalence, mechanisms of traumatic injuries, and number of injury-related deaths in a low-income country. DESIGN A randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in 2012. SETTING Sierra Leone, Africa. PARTICIPANTS Three thousand seven hundred fifty randomly selected participants throughout Sierra Leone. MAIN OUTCOME MEASURES Mechanisms of injury based on age, sex, anatomic location, cause, and sociodemographic factors as well as mechanisms of injury-related deaths in the previous year were the primary outcome measures. RESULTS Data were collected and analyzed from 1843 households and 3645 respondents (98% response rate). Four hundred fifty-two respondents (12%) reported at least 1 traumatic injury in the preceding year. Falls were the most common cause of nonfatal injuries (40%). The extremities were the most common injury site regardless of age or sex. Traffic injuries were the leading cause of injury-related deaths (32% of fatal injuries). CONCLUSIONS This study provides baseline data on the mechanisms of traumatic injuries as well as the sociodemographic factors affecting injury prevalence in one of the world's poorest nations. It is anticipated that these data will provide an impetus for further studies to determine injury severity, associated disability, and barriers to accessing care in these resource-poor areas.
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Henry JA, Groen RS, Price RR, Nwomeh BC, Kingham TP, Hardy MA, Kushner AL. The benefits of international rotations to resource-limited settings for U.S. surgery residents. Surgery 2013; 153:445-54. [DOI: 10.1016/j.surg.2012.10.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022]
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Petroze RT, Groen RS, Niyonkuru F, Mallory M, Ntaganda E, Joharifard S, Guterbock TM, Kushner AL, Kyamanywa P, Calland JF. Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery 2012; 153:457-64. [PMID: 23253378 DOI: 10.1016/j.surg.2012.10.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda. METHODS The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics. RESULTS A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8-43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3-16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6-7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services. CONCLUSION The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda.
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Affiliation(s)
- Robin T Petroze
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
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Groen RS, Kamara TB, Dixon-Cole R, Kwon S, Kingham TP, Kushner AL. A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. World J Surg 2012; 36:1970-7. [PMID: 22488329 DOI: 10.1007/s00268-012-1591-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A first step toward improving surgical care in many low and middle income countries is to document the need. To facilitate the collection and analysis of surgical capacity data and measure changes over time, Surgeons OverSeas (SOS) developed a tool and index based on personnel, infrastructure, procedures, equipment, and supplies (PIPES). METHODS A follow-up assessment of 10 government hospitals in Sierra Leone was completed 42 months after an initial survey in 2008 using the PIPES tool. An index based on number of operating rooms, personnel, infrastructure, procedures, equipment, and supplies was calculated. An index was also calculated, using the 2008 data for comparison. RESULTS Most hospitals demonstrated an increased index that correlated with site visits that verified improved conditions. Connaught Hospital in Sierra Leone had the highest score (9.2), consistent with its being the best equipped and staffed Ministry of Health and Sanitation facility. Makeni District Hospital had the greatest increase, from 3.8 to 7.5, consistent with a newly constructed facility. DISCUSSION The PIPES tool was easily administered at hospitals in Sierra Leone and an index was found useful. Surgical capacity in Sierra Leone improved between 2008 and 2011, as demonstrated by an increase in the overall PIPES indices.
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Affiliation(s)
- Reinou S Groen
- Surgeons OverSeas (SOS), 225 East 6th Street, Suite 7F, New York, NY 10003, USA
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Groen RS, Samai M, Stewart KA, Cassidy LD, Kamara TB, Yambasu SE, Kingham TP, Kushner AL. Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 2012; 380:1082-7. [PMID: 22898076 DOI: 10.1016/s0140-6736(12)61081-2] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical care is increasingly recognised as an important part of global health yet data for the burden of surgical disease are scarce. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) was developed to measure the prevalence of surgical conditions and surgically treatable deaths in low-income and middle-income countries. We administered this survey countrywide in Sierra Leone, which ranks 180 of the 187 nations on the UN Development Index. METHODS The study was done between Jan 9 and Feb 3, 2012. 75 of 9671 enumeration areas, the smallest administrative units in Sierra Leone, were randomly selected for the study clusters, with a probability proportional to the population size. In each cluster 25 households were randomly selected to take part in the survey. Data were collected via handheld tablets by trained local medical and nursing students. A household representative was interviewed to establish the number of household members (defined as those who ate from the same pot and slept in the same structure the night before the interview), identify deaths in the household during the previous year, and establish whether any of the deceased household members had a condition needing surgery in the week before death. Two randomly selected household members underwent a head-to-toe verbal examination and need for surgical care was recorded on the basis of the response to whether they had a condition that they believed needed surgical assessment or care. FINDINGS Of the 1875 targeted households, data were analysed for 1843 (98%). 896 of 3645 (25%; 95% CI 22·9-26·2) respondents reported a surgical condition needing attention and 179 of 709 (25%; 95% CI 22·5-27·9) deaths of household members in the previous year might have been averted by timely surgical care. INTERPRETATION Our results show a large unmet need for surgical consultations in Sierra Leone and provide a baseline against which future surgical programmes can be measured. Additional surveys in other low-income and middle-income countries are needed to document and confirm what seems to be a neglected component of global health. FUNDING Surgeons OverSeas, Thompson Family Foundation.
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Leow JJ, Groen RS, Kingham TP, Casey KM, Hardy MA, Kushner AL. A preparation guide for surgical resident and student rotations to underserved regions. Surgery 2012; 151:770-8. [PMID: 22652117 DOI: 10.1016/j.surg.2012.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
Abstract
Interest in global health among surgical residents and medical students is growing. There are numerous opportunities worldwide for both short- and long-term experiences. In order to maximize the learning potential, the authors present a practical guide for residents and students to prepare for a surgical visit, elective, rotation, or mission to an underserved region. The following steps will be outlined:
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Henry JA, Windapo O, Kushner AL, Groen RS, Nwomeh BC. A Survey of Surgical Capacity in Rural Southern Nigeria: Opportunities for Change. World J Surg 2012; 36:2811-8. [DOI: 10.1007/s00268-012-1764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jackson-Cole J, Pratt D, Forde M, Bangura J, Groen RS, Kushner AL, Kamara TB. A retrospective study of burns patients at a major government referral hospital in Freetown, Sierra Leone. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leow JJ, Pozo ME, Groen RS, Kushner AL. Social media in low-resource settings: A role for Twitter and Facebook in global surgery? Surgery 2012; 151:767-9. [DOI: 10.1016/j.surg.2011.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 12/22/2011] [Indexed: 11/25/2022]
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Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012; 206:456-62. [PMID: 22244469 DOI: 10.1016/j.ajog.2011.12.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/18/2011] [Accepted: 12/06/2011] [Indexed: 11/18/2022]
Abstract
Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.
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Abstract
OBJECTIVE To review the current training opportunities for ultrasound use for health workers practising in low- and middle-income countries (LMICs). METHODS A PubMed search using terms ultrasound, sonography, echocardiography, developing country/countries, developing world, low resource settings, low income country/countries, training and education was conducted. Articles from 2000 to 2011 that included data on ultrasonography training were eligible for inclusion. RESULTS This review shows that most ultrasound scans are performed by generalist and obstetric physicians and even non-medical personnel with little to no formal training in ultrasonography. The spectrum of ultrasonography training described spanned from no formal training to formal certification and residency programmes. All courses included some component of didactics and hands-on training. Follow-up of trainee skills ranged from none, to telemedicine case review, to formal re-evaluations and intensive refresher courses. Ultrasonographic training in LMICs often does not meet the WHO criteria such as the number of scans under supervision and length of training programme recommended by WHO. Nevertheless, some programmes manage to have excellent outcomes with regard to diagnostic accuracy and retention of knowledge by trained personnel. CONCLUSION Regulation and quality control of training in ultrasound skills for those working in LMICs can be improved. Research on effective training and follow-up should be encouraged.
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Affiliation(s)
- Lacey N LaGrone
- Department of Surgery, University of Washington, Seattle, WA, USA
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