Population-based Method to Assess Burden of Surgical Conditions in Uganda: A Pilot Study

Background Globally, it is estimated that 11% of all disability adjusted life years lost result from conditions requiring surgical intervention. Efforts to estimate burden at country-specific levels have been recommended to plan surgical delivery platforms. However, existing analyses of hospital records are not representative of population-level needs. Therefore, we piloted a population-level epidemiologic survey in a large, peri-urban District of Uganda. The exercise would inform implementation of the eventual nation-wide survey of Uganda.

Methods A 2-stage cluster sampling design was used to sample fifty five (55) households. In each household, up to 2 individual respondents were recruited. Village Health Team (VHT) members served as enumerators and used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument to acquire self-reported data on existing surgical conditions and surgical history. A head/representative of household was asked about household deaths within the previous 12-months. Descriptive statistics, weighted adjustments, and regression modeling were used to analyze results.

Results Six of 96 individual respondents (6.25%) reported an existing surgical condition. The lifetime prevalence of surgical conditions was 26.0% (25 of 96 individuals), reporting 33 total surgical conditions. The most commonly reported problems were wound related (54.5% - 18 of 33). The most common anatomic regions affected were face/head/neck, extremities, and abdomen. Injuries were responsible for 51.5% of reported surgical conditions. Two of three household deaths involved proximate causes that were surgically treatable. For all met and unmet need, 80% (20 of 25 individuals) were treated or need treatment at a District Hospital or lower level facility.

Prevalence of existing surgical conditions was used in this pilot to compute a nation-wide study sample size of 4,750. The pilot study cost USD 25/respondent and averaged 36 minutes per household. Major revisions in deployment of the nation-wide survey included: hiring enumerators who lived in the EAs, random household sampling, shift in data collection equipment, and improving breath and depth of data acquired by the SOSAS instrument.

Conclusion The prevalence of existing surgical conditions in Wakiso District was within range of previous pilot studies deploying the same SOSAS instrument, albeit not from Uganda. A large proportion of individuals have surgical problems that can be treated at District Hospital or lower level facilities. The pilot study was feasible and necessary to inform deployment of the nation-wide survey.