Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countries

Gupta, Shailvi; Groen, Reinou S.; Kyamanywa, Patrick; Ameh, Emmanuel A.; Labib, Mohamed A.; Clarke, Damian; Donkor, Peter; Derbew, Miliard; Sani, Rachid; Kamara, Thaim B.; Shrestha, Sunil; Nwomeh, Benedict C.; Wren, Sherry M.; Price, Raymond R.; Kushner, Adam L.

doi:10.1016/s0140-6736(15)60796-6

Cited by 23 publications

(22 citation statements)

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“…It has been estimated that in 48 African countries, 288 million people are living with a surgically treatable condition, and that 5.6 million deaths could be averted by surgical intervention annually. 9 These extrapolated figures from three previous SOSAS studies demonstrate the clear need of surgical care scale up in the African region as a whole. It is high time surgical conditions become a main stream part of the global health discussion.…”

Section: Discussionmentioning

confidence: 88%

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

Varela¹,

Young²,

Groen³

et al. 2017

Mal. Med. J

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BackgroundNoncommunicable diseases, such as surgical conditions have received little attention from public health planners in low income countries (LIC) like Malawi. Though increasingly recognised as a growing global health problem, the burden of surgical pathologies and access to surgical care has not been adequately identified in many LIC. Information on the spectrum and burden of surgical disease in Malawi is important to uncover the unmet need for surgery and for planning of the National Health Service.MethodsThis was a multistage random cluster sampling national survey. Households were selected from clusters using probability proportional to size method. 1448 households and 2909 interviewees were analysed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used to collect data. This electronic tablet based questionnaire tool included general information and a dual personalised head to toe inquiry on surgical conditions. The general information included number of household members, and inquired on any death within the past twelve months, and if any of the deaths in the family had a suspected surgical condition leading to that death. Data was collected by specially trained third year medical students.ResultsOut of 1480 selected households, 1448 (98%) agreed to participate, with 2909 interviewed individuals included in the study. The median household size was 6 individuals (range 1 – 47). Median age of interviewed persons was 35 years (range 0.25 – 104 years). 1027 out of 2909 (35%) of the interviewed people reported to be living with a condition requiring surgical consultation or intervention, whereas 146 of 616 (24%) of the total deaths reported to have occurred in the preceding 12 months were reported to have died from a surgically related condition. Most individuals did not seek health care due to lack of funds for transportation to the health facility. Only 3.1% of those that reported a surgical condition had surgical intervention.ConclusionsThere is a large unmet need for surgical care in Malawi. A third of the population is living with a condition needing surgical consultation or intervention, and a quarter of all deaths are potentially avoidable with surgery. Urgent scale up of surgical services and training are needed to reduce this huge gap in public health planning in the country.

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Section: Discussionmentioning

confidence: 88%

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

Varela¹,

Young²,

Groen³

et al. 2017

Mal. Med. J

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“…Unfortunately, appendicitis continues to have disparate outcomes in different populations around the world and remains associated with increased severity and worse outcomes in South Africa when compared to appendicitis in other LMIC (19–21). Patients with aappendicitis in South Africa have increased rates of perforation and poorer outcomes (22).…”

Section: Discussionmentioning

confidence: 99%

Increased anatomic severity in appendicitis is associated with outcomes in a South African population

Hernandez

Kong

Aho

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Severity of emergency general surgery diseases (EGS) has not been standardized until recently. The American Association for the Surgery of Trauma (AAST) proposed an anatomic severity grading system for EGS diseases to facilitate communication and quality comparisons between providers and hospitals. Previous work has demonstrated validity of the system for appendicitis in the United States. In order to demonstrate generalizability, we aim to externally validate this grading system in South African patients with appendicitis. Methods Patients with acute appendicitis during 2010–2016 were identified at multi institutional sites within South Africa. Baseline demographics and procedure types were recorded and AAST grades were assigned based on intraoperative findings. Outcomes included duration of stay, mortality, and Clavien-Dindo complications. Summary statistical univariate and nominal logistic regression analyses were performed to compare AAST grade and outcomes. Results A total of 1415 patients with a median [IQR] age of 19 years [14–28] were included (55% male). 100% underwent appendectomy: 63.5% completed via midline laparotomy, 36.5% via limited incision (31.8% via McBurney incision and 4.7% via laparoscopy). Overall 30-day mortality rate was 1.4% with an overall complication rate of 44%. Most common complications included: surgical site infection (n=147, 10.4%), pneumonia (n=105, 7.4%), and renal failure (n=64, 4.5%). Distribution of AAST grade is as follows: Grade 0 (10, 0.7%), Grade I (247, 17.4%), Grade II (280, 19.8%), Grade III (158, 11.3%), Grade IV (179, 12.6%), and Grade V (541, 38.2%). Increased median [IQR] AAST grades were recorded in patients with complications, 5 [3–5], compared to those without, 2 [1–3], p=0.001. Duration of stay was increased for patients with higher AAST grades: IV and V (10.6 ±5.9 days) versus I and II (3.6 ±4.3 days), p=0.001. AUROC analysis to predict presence of any complication based on AAST grade was 0.90. Conclusion The AAST EGS grading system is valid to predict important clinical outcomes in a South African population with an increased degree of severity on presentation. These results support generalizability of the AAST EGS grading system for appendicitis in a developing nation. Level of evidence Level 4 – Multi institutional retrospective study Study type Retrospective multi institutional study

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“…These treatment options available to women in these settings have helped many women conserve their fertility. In contrast, access to modern broid surgical care is largely out of reach for most women in low and middle income settings because the medical equipment, infrastructure and specialized personnel required for such interventions are not widely available (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

Millien

Manzi

Katz

et al. 2020

Preprint

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Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported lifetime cumulative incidence of 59% among Black women in the U.S. Uterine fibroids increase mortality, morbidity, and negatively impact the quality of women’s lives. To our knowledge, no study has been published in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed a structured questionnaire. In-depth interviews with a subset of 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results The prevalence of uterine fibroids was 60.1%. Anemia and infertility were the most frequent complications— 52.6% and 33.6%, respectively. Factors associated with uterine fibroids included income decline (OR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (OR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (OR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and presence of micro polycystic ovarian syndrome were found to be protective (OR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (OR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. Qualitative findings demonstrated that uterine fibroids deeply affected the quality of women’s lives. The concept of a poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty and women’s experience with fibroids demonstrate the long-term struggle that women endure. Health system strengthening, social support, and economic improvement are keys to alleviate women’s suffering and promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countries

Abstract: None.

Cited by 23 publications

References 0 publications

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

Increased anatomic severity in appendicitis is associated with outcomes in a South African population

Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

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