Surgical need among the ageing population of Uganda

Abstract

Background Uganda's ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgically-treatable conditions is unknown. Objectives To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. Methods A cluster randomized sample representing the national population of Uganda was enumerated. The previously validated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any surgically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation. Results The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1–34.3). This extrapolates to 694,722 (95%CI, 552,279–857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes. Conclusion There is disproportionately high need for surgical care among the ageing population of Uganda with approximately 700,000 consultations needed.

Acceptability of surgical care in Uganda: a qualitative study on users and providers

“…Many participants from all groups highlighted the dangers of misdiagnosis and delay of treatment, which has been previously reported5 29 and was discussed by WHO in their traditional medicine strategy 41. However, patients continue to seek care from traditional healers, which healthcare providers attributed to the fact that traditional healers often spend more time with patients.…”

“…1 Surgical care, which is defined as 'any intervention directed at reducing the disability or premature death associated with a surgical condition', 2 has been found to be highly effective in reducing the burden of disease and disability-adjusted life-years lost. 3 Uganda faces a high unmet need for surgery, [4][5][6] with few operating theatres (OTs) (0.2 major OTs per 100 000 people) 7 and a low surgeon density of 0.73 surgeons per 100 000 persons. 6 Wards are overbooked 8 and shortages of necessities such as water, electricity, equipment and limited access to blood banks further hinder safe surgical care.…”

Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment

“…People aged 65 years and above accounted for about 31% of admissions in a surgery ward in Ethiopia [ 41 ]. The prevalence of the unmet surgical need of older people in Uganda was 27.8% in 2014 [ 5 ]. During the same year in Ghana, the annual operation rate of people aged 65 and over was 1744 per 100,000 [ 6 ].…”

“…With the ongoing epidemiological transition in sub-Saharan Africa (SSA), there is a rising trend in non-communicable diseases (NCDs), including conditions requiring surgical procedures and anesthetic care [ 3 , 4 ]. The prevalence of unmet surgical need for older people in Uganda was 27.8% in 2014 [ 5 ]. The same year in Ghana, the annual operation rate of people aged 65 and over was 1744 per 100,000 [ 6 ].…”

Infections, NCDS, and the scourge of cyclones and Ebola in sub-Saharan Africa

“…Strange bed fellows? Hence, we have a paper on the use of the laryngeal mask on post-operative sore throat47, vortioxetin for depression48, orthopedic back pain and depression49, propofol for emergency tonsillectomy50, elective abdominal surgery complications51, hypertensive crises52, surgical emergencies53, surgical needs of the elderly54, and prophylactic removal of the third molar55.…”