Survey of surgical emergencies in a rural population in the Northern Areas of Pakistan

Abstract

Summaryobjective To determine the incidence of specific surgical emergencies in a mountainous rural community in the Northern Areas of Pakistan and to assess use of existing health services, and outcomes related to acute surgical illness events.method A cross-sectional population-based survey was conducted. Interviewers visited each of 118 villages in the study area (population 100000), selected a random sample from a total of 9900 households, and interviewed the oldest premenopausal female member (n ϭ 836). Questions were focused on injury, acute abdomen, and/or maternal morbidity occurring in the past year. Cases were included as surgical emergencies when one or more index clinical features indicating a potential for surgical intervention were present. Mortality from a wider range of surgical emergencies was also elicited based on the respondent's lifetime knowledge of the household.results The incidence rates were 1531/100000 persons per year for injuries; 1364/100000 for acute abdomen, and 16462/100 000 for maternal morbidity. The rate of injuries was 2.7 times higher and that of acute abdomen twice as high in males as in females. The injury rate decreased with advancing age, being 13 times higher in children Ͻ 5 years than in adults Ͼ 40. By contrast, the rate for acute abdomen showed a rise with advancing age, being 8 times higher in the Ͼ 40 age group than in under-fives. Burns, falls and road accidents, in that order, were the commonest forms of injury accounting for 82% of 138 cases. Of 43 burn casualties, 46% were in the age group Ͻ 5 years; there was no gender bias. Of 71 casualties from falls and road accidents, 85% were aged 6-40 years; there was 6 : 1 male predominance. The maternal morbidity rate was highest in the age group 25-35 years and may be attributed to the high pregnancy rate in this age bracket. Of 408 patients with acute surgical illness, 85% were managed initially at home or close to home in a health centre, dispensary or civil hospital; 32% eventually sought specialist surgical care. The overall rate for minor and major surgical procedures was 411/100000 persons per year (lowest estimate), and appeared to be low. The rate of operative deliveries at 11.8/1000 deliveries (lowest estimate) was particularly low. The mortality rates were correspondingly high: 55/100000 persons per year for injuries and for acute abdomen (lowest estimates). The maternal mortality ratio was particularly high at 8.9/1000 deliveries (lowest estimate). Annual mortality rates derived from deaths recalled during the respondent's lifetime in the household (mean period ϭ 26 years), tended to corroborate the results of the 1-year survey.conclusion The incidence rates for broad categories of serious acute surgical illness in the study population far exceeded the rates of acute surgical intervention. Mortality rates were correspondingly high. Such evidence points to a large unmet surgical need and ought to spur improvements in the health service.

Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review

“…While recognizing that the burden of surgical diseases has yet to be quantified in Pakistan (or any other country) using existing health metrics, considerable morbidity and mortality may be averted by providing access to safe and timely surgical care for a host of emergent conditions including complications of pregnancy and injuries. For example, the incidence of injuries in the northern areas of Pakistan was estimated to be 1531/100 000 persons per year, with burns, falls, and road accidents accounting for 82% of cases [3]. The incidence of acute abdomen was 1364/ 100,000 persons per year in the same study, and between 39% and 47% of such cases require a surgical procedure [3,5,6].…”

“…For example, the incidence of injuries in the northern areas of Pakistan was estimated to be 1531/100 000 persons per year, with burns, falls, and road accidents accounting for 82% of cases [3]. The incidence of acute abdomen was 1364/ 100,000 persons per year in the same study, and between 39% and 47% of such cases require a surgical procedure [3,5,6].…”

“…Weiser et al estimated that the poorest third of our world's population receive only 3.5% of the total number of surgeries performed yearly [2]. In Pakistan, the rate of surgical procedures was 411 per 100,000 population (1999), versus 21,397 per 100,000 population in the United States (1996) [2][3][4]. While recognizing that the burden of surgical diseases has yet to be quantified in Pakistan (or any other country) using existing health metrics, considerable morbidity and mortality may be averted by providing access to safe and timely surgical care for a host of emergent conditions including complications of pregnancy and injuries.…”

Causes, magnitude and management of burns in under-fives in district hospitals in Dar es Salaam, Tanzania.

“…Its activity is based on its osmotic effect of its high sugar content and like other sugar syrups and sugar pastes has an osmolarity sufficient to inhibit microbial growth (13)(14)(15). Honey has also lymphocyte and phagocytic activity and to some extent activates the immune response to infection (16)(17). Adverse reactions with honey are rare, and there was no adverse reaction noted other than a localized stinging sensation described by some patients which may be due to the acidity of honey as it has not been reported when the acidity is neutralized (18)(19)(20).…”

Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: A prospective study of admissions and outpatients

“…It is likely that the presence and wide use of heating and cooking devices and other equipment and products (such as tea utensils) at homes as well as family attitudes and practices regarding home safety, contribute to the high incidence of burn injuries in young children. High burn rates in young children are reported from other countries such as 660 per 100,000 amongst children aged 0-4 years in the USA [12], 782 (only non-fatal burns) in Bangladesh [13] and 1388 per 100,000 reported amongst children below 5 years by a study from Pakistan [14]. The burn admission rate in our study (82 per 100,000 per year) is also consistent with a study from Iran rate of 103 admissions per 100,000 amongst children aged 0-1 years [15] but higher than Kuwait, 34 admissions per 100,000 per year [16] and New York, 67 admissions per 100,000 per years [3].…”