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Estimating operative disease prevalence in a low-income country: Results of a nationwide population survey in Rwanda

Published:December 18, 2012DOI:https://doi.org/10.1016/j.surg.2012.10.001

      Background

      Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda.

      Methods

      The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics.

      Results

      A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8–43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3–16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6–7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services.

      Conclusion

      The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda.
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      References

        • Farmer P.E.
        • Kim J.Y.
        Surgery and global health: a view from beyond the OR.
        World J Surg. 2008; 32: 533-536
        • Weiser T.G.
        • Regenbogen S.E.
        • Thompson K.D.
        • Haynes A.B.
        • Lipsitz S.R.
        • Berry W.R.
        • et al.
        An estimation of the global volume of surgery: a modelling strategy based on available data.
        Lancet. 2008; 372: 139-144
        • Funk L.M.
        • Weiser T.G.
        • Berry W.R.
        • Lipsitz S.R.
        • Merry A.F.
        • Enright A.C.
        • et al.
        Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.
        Lancet. 2010; 376: 1055-1061
      1. Jamison D.T. Breman J.G. Measham A.R. Priorities in health. World Bank, Washington, DC2006 (Table of Contents, Disease Control Priorities in Developing Countries, 2nd ed. Available from:)
        • National Institute of Statistics of Rwanda (NISR) [Rwanda] MoHMR, and ICF International
        Rwanda demographic and health Survey s010.
        NISR, MOH, and ICF International, Calverton, MD2011
        • Republic of Rwanda Ministry of Finance and Economic Planning
        EDPRS: Lessons Learned 2008-2011.
        MINECOFIN, Kigali, Rwanda2012 (Available from)
        • Macro International Inc
        Sampling manual. DHS-III Basic documentation No. 6.
        Macro International Inc, Calverton, MD1996
        • World Health Organization, UNICEF, UNFPA and the World Bank
        Trends in maternal mortality: 1990-2010.
        WHO, Geneva, Switzerland2012 (Available from)
        • Lopez A.D.M.C.
        • Ezzati M.
        • Jamison D.T.
        • Murray C.J.
        Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.
        Lancet. 2006; 367: 1747-1757
        • Ozgediz D.
        • Riviello R.
        The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa.
        PLoS Med. 2008; 5: e121
        • Petroze R.T.
        • Nzayisenga A.
        • Rusanganwa V.
        • Ntakiyiruta G.
        • Calland J.F.
        Comprehensive national analysis of emergency and essential surgical capacity in Rwanda.
        Br J Surg. 2012; 99: 436-443
      2. Surgeons OverSeas. Available from www.humanitariansurgery.org.

        • Groen R.S.
        • Samai M.
        • Petroze R.T.
        • Kamara T.B.
        • Yambasu S.E.
        • Calland J.F.
        • et al.
        Pilot testing of a population-based surgical survey tool in Sierra Leone.
        World J Surg. 2012; 36: 771-774
        • Atijosan O.
        • Rischewski D.
        • Simms V.
        • Kuper H.
        • Linganwa B.
        • Nuhi A.
        • et al.
        A national survey of musculoskeletal impairment in Rwanda: prevalence, causes and service implications.
        PLoS One. 2008; 3: e2851
        • Atijosan O.
        • Kuper H.
        • Rischewski D.
        • Simms V.
        • Lavy C.
        Musculoskeletal impairment survey in Rwanda: design of survey tool, survey methodology, and results of the pilot study (a cross sectional survey).
        BMC Musculoskelet Disord. 2007; 8: 30
        • Bennett S.
        • Woods T.
        • Liyanage W.
        • Smith D.
        A Simplified general method for cluster-sample surveys of health in developing countries.
        World Health Stat Q. 1991; 44: 98-106
        • Henderson R.
        • Sundaresan T.
        Cluster sampling to assess immunization coverage: a review of experience with simplified sampling method.
        Bull World Health Organ. 1982; 60: 253-260
        • Ren R.
        Sample design for the Fourth Rwanda Demographic and Health Survey in 2010 (RDHS-IV).
        ICF Macro. 2010;
      3. Rwanda National Institute of Statistics. National Population Projection, 2007-2022. July 2009. Available from www.statistics.gov.rw.

        • Nair H.
        • Shu X.O.
        • Volmink J.
        • Romieu I.
        • Spiegelman D.
        Cohort studies around the world: methodologies, research questions and integration to address the emerging global epidemic of chronic diseases.
        Public Health. 2012; 126: 202-205
        • Hughes B.B.
        • Kuhn R.
        • Peterson C.M.
        • Rothman D.S.
        • Solorzano J.R.
        • Mather C.D.
        • et al.
        Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model.
        Bull World Health Organ. 2011; 89: 478-486
        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3: e442