Background
With an aging global population comes an obligate and substantial burden of noncommunicable
disease, especially in low- and middle-income countries. An unknown proportion of
this burden is treatable with surgical expertise. For health system planning, this
study aimed to estimate the operative needs of individuals older than 50 of age years
in Nepal.
Methods
A 2-stage, cluster randomized, community-based survey was performed in Nepal using
the validated Surgeons OverSeas Surgical Assessment Survey (SOSAS). SOSAS collects
household demographics and selects household members randomly for verbal, head-to-toe
examinations for surgical conditions; moreover, SOSAS also completes a verbal autopsy
for deaths in the preceding year. Only respondents older than 50 years were included
in the analysis.
Results
The survey sampled 1,350 households, totaling 2,695 individuals (97% response rate).
Of these, 273 surgical conditions were reported by 507 persons ages ≥50 years. Extrapolating,
there are potentially 2.1 million people older than 50 years of age with surgically
treatable conditions who need care in Nepal (95% confidence interval 1.8–2.4 million;
46,000–62,600 per 100,000 persons). One in 5 deaths was potentially treatable or palliated
by surgical care. Although growths or masses (including hernias and goiters) were
the surgical condition reported most commonly (25%), injuries and fractures also were
common and associated with the greatest disability. Literacy and distance to secondary
and tertiary health facilities were associated with lack of care for operative conditions
(P < .05).
Conclusion
There is a large, unmet surgical need among the elderly in Nepal. Low literacy and
distance from a capable health facility are the greatest barriers to care. As the
global population ages, there is an increasing need to improve surgical services and
strengthen health systems to care for this group.
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References
- WHO global report on falls prevention in older age.in: Salas-Rojas C. Department of Aging and Life Course, World Health Organization, Geneva2007
- Grey matter: ageing in developing countries.Lancet. 2012; 379: 1285-1287
- Global status report on non-communicable diseases 2010.World Health Organization, Geneva2010
- Global disease burden of conditions requiring emergency surgery.Br J Surg. 2014; 101: e9-e22
- The impact of frailty in the elderly on the outcome of surgery in the aged.Adv Surg. 2010; 44: 229-249
- Comparison of two comorbidity scoring systems for older adults with traumatic injuries.J Am Coll Surg. 2014; 219: 631-637
- Perioperative Mortality Rate (POMR): a global indicator of access to safe surgery and anaesthesia.World J Surg. 2015; 39: 856-864
- Assessment of cesarean delivery availability in 26 low- and middle-income countries: a cross-sectional study.Am J Obstet Gynecol. 2014; 211: 504.e1-504.e12
- An estimation of the global volume of surgery: a modelling strategy based on available data.Lancet. 2008; 372: 139-144
- Pilot testing of a population-based surgical survey tool in Sierra Leone.World J Surg. 2012; 36: 771-774
- Guidelines for Conducting Community Surveys on Injuries and Violence.World Health Organization, Geneva2004
- State of non-communicable diseases in Nepal.BMC public health. 2014; 14: 23
- Surgical needs of Bepal: pilot study of population based survey in Pokhara, Nepal.World J Surg. 2014; 38: 3041-3046
- Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey.Lancet. 2012; 380: 1082-1087
Nepal Central Bureau of Statistics. Population. District and Municipal Level Report 2014 [cited 2014 September 2nd]; Available from: http://cbs.gov.np/?cat=7.
- Utilisation of Health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.Matern Child Health J. 2015; 19: 566-577
Annual Report, Department of Health Services, Ministry of Health and Population, Nepal. 2012 [cited 2014 August 1st, 2014]; Available from: http://phpnepal.org/index.php?listId=453-.U6R7iJSSy2E.
- Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India.Burns. 2013; 39: 558-564
- Surgical risk factors, morbidity, and mortality in elderly patients.J Am Coll Surg. 2006; 203: 865-877
- The impact of age on mortality in patients in extremis undergoing urgent intervention.Am Surg. 2013; 79: 1248-1252
- New developments in geriatric surgery.Curr Probl Surg. 2011; 48: 670-754
- Prevalence of surgical conditions in individuals aged more than 50 years: a cluster-based household survey in Sierra Leone.World J Surg. 2015; 39: 55-61
- A proposed matrix for planning global surgery interventions.World J Surg. 2014; 38: 3039-3040
- Systematic review of barriers to surgical care in low-income and middle-income countries.World J Surg. 2011; 35: 941-950
- Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care.Arch Surg. 2009; 144 (discussion 128): 122-127
- Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma.J Trauma. 1997; 42 (discussion 511–3): 504-511
- A diagonal approach to building primary healthcare systems in resource-limited settings: women-centred integration of HIV/AIDS, tuberculosis, malaria, MCH and NCD initiatives.Trop Med Int Health. 2012; 17: 1426-1431
- Improvement of child survival in Mexico: the diagonal approach.Lancet. 2006; 368: 2017-2027
- Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.PLoS Med. 2010; 7: e1000243
- Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group.PLoS Med. 2009; 6: e1000200
- Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps.Soc Sci Med. 2014; 102: 190-200
- Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.World J Surg. 2014; 38: 252-263
- Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care.World J Surg. 2010; 34: 374-380
- Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128
- The burden of surgical conditions and access to surgical care in low- and middle-income countries.Bull World Health Organ. 2008; 86: 646-647
- Incidence and outcome of injury in Ghana: a community-based survey.Bull World Health Organ. 1999; 77: 955-964
World_Bank_Group. World Development Indicators. GNI per capita: Atlas method 2014 [cited 2014 August 1st]; Available from: http://data.worldbank.org/indicator/NY.GNP.PCAP.CD/countries.
- Demographic and socioeconomic statistics: crude birth and death rate.WHO, Geneva2012
Article info
Publication history
Accepted:
December 3,
2014
Footnotes
Logistical and transportation funding for the survey was provided by the 2014 Global Surgery Research Fellowship Award provided by the Association for Academic Surgery and from Surgeons OverSeas, a United States-based nongovernmental organization. Data analysis and manuscript preparation was done with funding from the Fogarty International Center, US National Institutes of Health, through the Northern Pacific Global Health Research Fellows Training Consortium under grant number R25TW009345.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
