Elsevier

Surgery

Volume 153, Issue 4, April 2013, Pages 457-464
Surgery

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

https://doi.org/10.1016/j.surg.2012.10.001Get rights and content

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.

Section snippets

Survey design

The SOSAS survey tool is modeled on DHS surveys as well as the WHO Guidelines for Conducting Community Surveys for Injuries and Violence. A research group comprising 46 international surgeons and public health experts provided input during the SOSAS development project. Designed for direct computer-based entry, a functional pilot of the study evaluating the ease and utility of use on iPad tablets was conducted in Sierra Leone in August 2011.13 Local adaptations were made on the basis of

Demographics

Figure 1 shows the location of the 52 sampled clusters based upon GPS coordinates taken at the index household. A total of 1626 households were sampled with a 99% response rate. A household representative completed the first section of the survey regarding overall household demographics, access to medical care, and household deaths. Table I summarizes the demographics of the survey. The mean household size was 4.67 individuals with 59.9% having a female household representative. Each household

Discussion

This study represents the first implementation of a nationwide survey to document the prevalence of operative conditions at the community level. A total of 6.4% of the study sample—corresponding to an estimated 675,000 Rwandans—were determined to currently need operative care, with nearly 15%—an estimated 1.6 million Rwandans—reporting an operative condition within the previous year.

The results of this survey have important implications for the global operative community, and, more importantly,

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    Surgeons OverSeas (SOS) provided the survey tool, technical assistance, and funding for the logistical execution of the data collection, including the salaries of the interviewers and field supervisor. The UVA Department of Surgery provided funding for statistical analysis and consultative assistance with study design.

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