Browsing by Subject "burden"

Background: A staggering 5 billion people worldwide lack access to safe and affordable surgery, and surgical conditions contribute to up to 32% of the global disease burden. However, precise data on the burden of surgical conditions is lacking, particularly for children. This study aims to measure the burden of pediatric surgical conditions in Somaliland using a community-based, household, nationwide survey as well as a national hospital survey to identify the types and volume of pediatric surgical care.

Methods: We surveyed 1450 children, from 839 families, through national community-based sampling using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey to identify the prevalence of surgical conditions. We also performed a hospital capacity survey at 15 hospitals in Somaliland, with surgical records reviewed over a 1-year time frame to identify pediatric surgical procedures performed.

Results: Using a community survey, we identified 226 surgical conditions in 191 children, yielding a surgical condition prevalence of 13.7% in the pediatric population. Only 55 of 226 conditions were treated with a surgical procedure. The most common conditions reported were congenital deformities (34.4%) and wound related injuries (23.8%). Using a hospital survey, we identified 1255 pediatric surgical procedures performed nationally over 1 year. We found that 56.7% procedures were in performed in boys and 79.8% were done at private hospitals. The most common surgical diagnoses were tonsillitis, trauma/wound/snake bite, and hydrocephalus.

Conclusions: Between 91,500 – 209,000 children in Somaliland have an unmet need for pediatric surgery, highlighting the high burden of surgical disease in the country. The estimated number of performed surgical procedures represents a small fraction of the burden of pediatric surgical conditions, highlighting the need for expansion of infrastructure, resources, and workforce to provide needed surgical care.

An estimated 234.2 million major surgical procedures are performed annually worldwide, yet the wealthiest third of the world's population receives 73.6% while the world's poorest third receives only 3.5%. Approximately one-third of the global population has no access to basic surgical care. Knowing that large unmet surgical need in a community can lead to high morbidity and mortality in the population, the purpose of this novel study was to assess the level of surgical conditions in rural Gadchiroli, India as well as to conduct a quantitative assessment of the barriers to surgical care. In this retrospective, cross-sectional needs assessment, a study-specific survey was administered in a clinic-based setting. Of the 500 participants, 141 (28.2%) reported surgical conditions, for a total of 175 surgical cases, in the preceding two years. The conditions with the highest prevalence were hydrocele, anorectal processes, dysfunctional uterine bleeding, cataracts, appendicitis, and spondylosis with neurologic claudication. Assessment of the conditions by a healthcare provider occurred in 133 (76.6%) of the cases of which only 32 (24.1%) reported having undergone surgery during the two year period. Overall, in this population, the burden of surgical disease is higher than previously expected and while willingness to undergo surgery is high, the completion rate is quite low. Certain factors appear to predict difficulty in seeking or receiving surgical care, including lost wages (p=0.027), the amount of time that family members need to stay in the hospital to help (p=0.038), and time away from work (p=0.045). Targeting these factors is a first step towards addressing the unmet surgical needs in this rural community.