Levels of Surgical Disease and Predictors of Barriers to Care in Rural India

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.