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1.
Obstet Gynecol Clin North Am ; 49(4): 841-868, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36328684

RESUMEN

Interprofessional care relates to providing care to an individual in an integrated system of professionals who share and shift the care given, depending on the individual and population need. By broadening the scope of care given by health-care workers (HCWs) or shifting tasks through interprofessional care in Obstetrics and Gynecology, more women and their newborns can benefit from safe deliveries, decreased perinatal morbidity and mortality and through screening and early treatment prevent morbidity and mortality secondary to gynecologic diseases.


Asunto(s)
Ginecología , Obstetricia , Embarazo , Femenino , Recién Nacido , Humanos
2.
World J Surg ; 46(11): 2585-2594, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36068404

RESUMEN

BACKGROUND: Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. METHODS: This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. RESULTS: A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4-7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. CONCLUSION: PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013-2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment.


Asunto(s)
Fiebre Hemorrágica Ebola , Adulto , Estudios Transversales , Países en Desarrollo , Brotes de Enfermedades , Femenino , Necesidades y Demandas de Servicios de Salud , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Masculino , Prevalencia , Sierra Leona/epidemiología
3.
PLOS Glob Public Health ; 2(12): e0000810, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36962776

RESUMEN

Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.

4.
Malawi Med J ; 33(2): 73-81, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34777702

RESUMEN

Background: Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need. Aim: To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries. Methods: A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. Results: There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. Conclusion: An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.


Asunto(s)
Personas con Discapacidad , Composición Familiar , Niño , Estudios Transversales , Humanos , Malaui/epidemiología , Prevalencia
5.
Int J Gynaecol Obstet ; 155(2): 290-295, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34403505

RESUMEN

OBJECTIVE: To identify risk factors for postpartum hemorrhage in a population of Alaska Native women. METHODS: A case-control study of 384 women (128 cases, 256 controls) delivering between August 1, 2018, and July 31, 2019, was conducted at a Level III maternal referral center for Alaska Native women in Alaska. Risk factors were assessed via retrospective chart review, and bivariate and conditional regression analyses were conducted to determine odds ratios (ORs) between women with and without postpartum hemorrhage. RESULTS: Body mass index ≥40 (OR 2.6, 95% confidence interval [CI] 1.4-4.5), antepartum bleeding (OR 6.3, 95% CI 1.2-31.6), previous postpartum hemorrhage (OR 5, 95% CI 2.6-9.8), suspected macrosomia (OR 2.7, 95% CI 1.4-5.3), macrosomia with birthweight ≥4000 g (OR 3.1, 95% CI 1.8-5.3), pre-eclampsia with magnesium sulfate (OR 4.0, 95% CI 2.0-8.0), length of third stage of labor >20 min (OR 2.2, 95% CI 1.1-4.4), oxytocin use >12 h (OR 5.4, 95% CI 2.0-14.6), residence in a rural community (OR 2.2, 95% CI 1.4-3.6), and vitamin D supplementation (OR 1.7, 95% CI 1.1-2.6) were associated with greater risk of postpartum hemorrhage. CONCLUSION: Analysis of clinical and geographic risk factors for postpartum hemorrhage in Alaska Native women identified important targets for prevention.


Asunto(s)
Hemorragia Posparto , Estudios de Casos y Controles , Femenino , Humanos , Madres , Hemorragia Posparto/epidemiología , Hemorragia Posparto/prevención & control , Embarazo , Estudios Retrospectivos
8.
Malawi med. j. (Online) ; 33(2): 73-81, 2021.
Artículo en Inglés | AIM (África) | ID: biblio-1284523

RESUMEN

Background:Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce longterm effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need.Aim: To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries. Methods A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. Results:There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. Conclusion: An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.


Asunto(s)
Humanos , Preescolar , Niño , Adolescente , Procedimientos Quirúrgicos Operativos , Heridas y Lesiones , Calidad de la Atención de Salud , Servicios Técnicos en Hospital , Malaui
9.
BMC Public Health ; 20(1): 1456, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32977777

RESUMEN

BACKGROUND: Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. METHODS: The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. RESULTS: The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. CONCLUSION: In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.


Asunto(s)
Familia , Niño , Estudios Transversales , Femenino , Humanos , Malaui/epidemiología , Masculino , Prevalencia , Encuestas y Cuestionarios
10.
JAMA Surg ; 155(2): 114-121, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31722004

RESUMEN

Importance: Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective: To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants: An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures: The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results: Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance: Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.


Asunto(s)
Conflictos Armados , Atención a la Salud/organización & administración , Unidades Móviles de Salud/organización & administración , Sistemas de Socorro/organización & administración , Guerra , Heridas y Lesiones/terapia , Congresos como Asunto , Consenso , Recolección de Datos , Atención a la Salud/normas , Técnica Delphi , Urgencias Médicas , Socorristas/educación , Humanos , Mejoramiento de la Calidad , Procedimientos de Cirugía Plástica , Sistemas de Socorro/normas , Medidas de Seguridad , Encuestas y Cuestionarios , Triaje , Heridas y Lesiones/rehabilitación , Heridas y Lesiones/cirugía
11.
Trop Med Int Health ; 24(9): 1128-1137, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31328362

RESUMEN

OBJECTIVES: Lack of access to safe surgery is seen as a major issue that needs to be addressed. The aim of this study was to understand which combinations of factors relate to high occurrences of unmet needs and disability in Nepal, and consequently, how to focus future work to maximise impact in this country. METHODS: A large population-based survey was conducted in Nepal in 2014 to evaluate the unmet surgical needs that result in disability. Recorded factors included diseased anatomical areas, disease specifics, disease locations, injury types, reasons for having an unmet need and the types of disability. RESULTS: Included in the study were 2695 individuals. The anatomical areas facing the highest disabling unmet surgical need were Head (3.9% of population), Groin/Genitalia (2.2% of population) and Extremities (3.6% of population). Four focus areas could be defined. Increase affordability, availability and acceptability of surgical care to non-traumatic disabling conditions of (i) the eye, and (ii) extremities, and (iii) to traumatic disabling conditions of extremities and finally (iv) increase acceptability of having surgical care for non-traumatic conditions in the groin and genital area. For the latter, fear/no trust was the main reason for receiving no surgical care despite the resulting shame. CONCLUSIONS: This study defined four focus areas that showed the largest unmet needs that resulted in a perceived disability. For those areas, affordability, availability and acceptability of surgical need to be addressed through technical developments, capacity building and raising awareness.


OBJECTIFS: L'absence d'accès à une chirurgie sûre est considérée comme un problème majeur à résoudre. Le but de cette étude était de comprendre quelles combinaisons de facteurs étaient liées aux besoins non satisfaits et aux incapacités au Népal, et par conséquent, comment cibler les travaux futurs pour maximiser l'impact dans ce pays. MÉTHODES: Une vaste enquête de population a été menée au Népal en 2014 pour évaluer les besoins chirurgicaux non satisfaits qui entraînent une incapacité. Les facteurs enregistrés comprenaient les zones anatomiques, les spécificités, les localisations de la maladie, les types de blessures, les raisons pour lesquelles les besoins n'étaient pas satisfaits et les types d'incapacité. RÉSULTATS: 2695 personnes ont été incluses dans l'étude. Les zones anatomiques impliquées dans des besoins chirurgicaux les plus invalidants étaient les suivantes: tête (3,9% de la population), aine/organes génitaux (2,2% de la population) et extrémités (3,6% de la population). Quatre domaines cibles d'intervention pourraient être définis. Premièrement, augmenter l'accessibilité financière, la disponibilité et l'acceptabilité des soins chirurgicaux aux affections invalidantes non traumatiques de 1) l'œil, 2) des extrémités et 3) aux affections traumatisantes des extrémités, et enfin 4) augmenter l'acceptabilité des soins chirurgicaux pour les affections non traumatiques dans l'aine et les parties génitales. Pour ces derniers, la crainte/l'absence de confiance était la principale raison de ne pas recevoir de soins chirurgicaux malgré la honte qui en résultait. CONCLUSIONS: Cette étude a défini quatre domaines cibles d'intervention qui ont montré les besoins non satisfaits les plus importants ayant entraîné une incapacité perçue. Pour ces domaines, il convient de prendre en compte le caractère abordable, la disponibilité et l'acceptabilité des interventions chirurgicales par le biais de développements techniques, d'un renforcement des capacités et la sensibilisation.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/psicología , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Gastos en Salud , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Nepal , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Procedimientos Quirúrgicos Operativos/economía , Adulto Joven
12.
BMC Public Health ; 19(1): 264, 2019 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-30836995

RESUMEN

BACKGROUND: It is estimated that nearly five billion people worldwide do not have access to safe surgery. This access gap disproportionately affects low-and middle-income countries (LMICs). One of the barriers to healthcare in LMICs is access to transport to a healthcare facility. Both availability and affordability of transport can be issues delaying access to health care. This study aimed to describe the main transportation factors affecting access and delay in reaching a facility for health care in Malawi. METHODS: This was a multi-stage, clustered, probability sampling with systematic sampling of households for transportation access to general health and surgical care. Malawi has an estimated population of nearly 18 million people, with a total of 48,233 registered settlements spread over 28 administrative districts. 55 settlements per district were randomly selected for data collection, and 2-4 households were selected, depending on the size. Two persons per household were interviewed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used by trained personnel to collect data during the months of July and August 2016. Analysis of data from 1479 households and 2958 interviewees was by univariate and multivariate methods. RESULTS: Analysis showed that 90.1% were rural inhabitants, and 40% were farmers. No formal employment was reported for 24.9% persons. Animal drawn carts prevailed as the most common mode of transport from home to the primary health facility - normally a health centre. Travel to secondary and tertiary level health facilities was mostly by public transport, 31.5 and 43.4% respectively. Median travel time from home to a health centre was 1 h, and 2.5 h to a central hospital. Thirty nine percent of male and 59% of female head of households reported lack financial resources to go to a hospital. CONCLUSION: In Malawi, lack of suitable transport, finances and prolonged travel time to a health care centre, all pose barriers to timely access of health care. Improving the availability of transport between rural health centres and district hospitals, and between the district and central hospitals, could help overcome the transportation barriers to health care.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Transportes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Costos y Análisis de Costo , Estudios Transversales , Países en Desarrollo , Empleo , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Malaui , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Viaje , Adulto Joven
13.
Ann Surg ; 267(6): 1173-1178, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-28151803

RESUMEN

OBJECTIVE: To examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning. BACKGROUND: Reliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women. METHODS: A 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship. RESULTS: We surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ±â€Š21.3 vs 27 ±â€Š16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011). CONCLUSIONS: Women experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.


Asunto(s)
Guerra de Irak 2003-2011 , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Distribución por Edad , Traumatismos por Explosión/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Costo de Enfermedad , Personas con Discapacidad/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Humanos , Renta , Irak/epidemiología , Masculino , Persona de Mediana Edad , Distribución por Sexo , Heridas y Lesiones/mortalidad , Heridas por Arma de Fuego/epidemiología , Adulto Joven
15.
Malawi Med J ; 29(3): 231-236, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-29872512

RESUMEN

Background: Noncommunicable diseases, such as surgical conditions have received little attention from public health planners in low income countries (LIC) like Malawi. Though increasingly recognised as a growing global health problem, the burden of surgical pathologies and access to surgical care has not been adequately identified in many LIC. Information on the spectrum and burden of surgical disease in Malawi is important to uncover the unmet need for surgery and for planning of the National Health Service. Methods: This was a multistage random cluster sampling national survey. Households were selected from clusters using probability proportional to size method. 1448 households and 2909 interviewees were analysed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used to collect data. This electronic tablet based questionnaire tool included general information and a dual personalised head to toe inquiry on surgical conditions. The general information included number of household members, and inquired on any death within the past twelve months, and if any of the deaths in the family had a suspected surgical condition leading to that death. Data was collected by specially trained third year medical students. Results: Out of 1480 selected households, 1448 (98%) agreed to participate, with 2909 interviewed individuals included in the study. The median household size was 6 individuals (range 1 - 47). Median age of interviewed persons was 35 years (range 0.25 - 104 years). 1027 out of 2909 (35%) of the interviewed people reported to be living with a condition requiring surgical consultation or intervention, whereas 146 of 616 (24%) of the total deaths reported to have occurred in the preceding 12 months were reported to have died from a surgically related condition. Most individuals did not seek health care due to lack of funds for transportation to the health facility. Only 3.1% of those that reported a surgical condition had surgical intervention. Conclusions: There is a large unmet need for surgical care in Malawi. A third of the population is living with a condition needing surgical consultation or intervention, and a quarter of all deaths are potentially avoidable with surgery. Urgent scale up of surgical services and training are needed to reduce this huge gap in public health planning in the country.


Asunto(s)
Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Mortalidad , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud/métodos , Humanos , Lactante , Malaui , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Pobreza , Población Rural , Encuestas y Cuestionarios , Población Urbana , Adulto Joven
16.
Int J Surg ; 33 Pt A: 49-54, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27450628

RESUMEN

BACKGROUND: The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e., a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or premature death; DALYs) in Sierra Leone and Nepal. METHODS: Data from nationwide, cluster-randomized, community-based surveys of surgical need in Sierra Leone and Nepal were used to model the incidence and prevalence of fractures stratified by met and unmet needs. DALYs incurred from treated and untreated fractures were estimated. Additionally, the investment necessary to eliminate avertable incident fracture DALYs was modeled through 2025 using published cost per DALY averted estimates. RESULTS: The incidence of treated and untreated fractures in Sierra Leone was 570 and 1004 fractures per 100,000 persons, respectively. There could be more than 2 million avertable fracture DALYs by 2025 in Sierra Leone and 2.5 million in Nepal requiring an estimated US$ 4,049,932 (range US$ 2,011,500-6,088,364) and US$ 4,962,402 (range US$ 2,464,701-7,460,103) to address this excess burden, respectively. CONCLUSION: This study identified a significant burden of untreated fractures in both countries, and an opportunity to avert more than 4.5 million DALYs in 10 years in a cost-effective manner. Prioritizing funding mechanisms for orthopaedic care and implants should be considered given the large burden of untreated fractures found in both countries and the long-term savings and functional benefit from properly treated fractures.


Asunto(s)
Fracturas Óseas/epidemiología , Costo de Enfermedad , Análisis Costo-Beneficio , Fracturas Óseas/economía , Costos de la Atención en Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Nepal/epidemiología , Años de Vida Ajustados por Calidad de Vida , Sierra Leona/epidemiología , Encuestas y Cuestionarios
17.
Geospat Health ; 11(2): 359, 2016 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-27245791

RESUMEN

Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R2=0.27). Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/cirugía , Accidentes por Caídas/estadística & datos numéricos , Altitud , Quemaduras/epidemiología , Necesidades y Demandas de Servicios de Salud , Humanos , Nepal/epidemiología , Análisis de Regresión , Características de la Residencia , Factores Socioeconómicos , Análisis Espacial , Temperatura
18.
Surgery ; 160(2): 501-8, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27158120

RESUMEN

BACKGROUND: Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool. METHODS: Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ(2) test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy. RESULTS: Of respondents with a surgical condition (n = 1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P < .001) and median transport costs to secondary and tertiary centers (P < .001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66-1.80, P < .01). Those without transport money were less likely to access care at any facility in all analyses (P < .01). CONCLUSION: The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration.


Asunto(s)
Países en Desarrollo , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud , Procedimientos Quirúrgicos Operativos , Adulto , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nepal , Factores Socioeconómicos , Adulto Joven
19.
World J Surg ; 40(11): 2628-2634, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27225996

RESUMEN

INTRODUCTION: Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives. METHODS: Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs. RESULTS: At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care. CONCLUSION: Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.


Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Naciones Unidas/estadística & datos numéricos , Adolescente , África del Norte , Niño , Preescolar , Colombia , Bases de Datos Factuales , República Democrática del Congo , Femenino , Humanos , Lactante , Recién Nacido , Internacionalidad , Irak , Masculino , Procedimientos Quirúrgicos Obstétricos/estadística & datos numéricos , Pakistán , Pediatría/estadística & datos numéricos , Siria , Poblaciones Vulnerables/estadística & datos numéricos
20.
Int J Gynaecol Obstet ; 134(1): 37-40, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27207110

RESUMEN

OBJECTIVE: To estimate awareness and prevalence of cervical smear testing among women in Nepal. METHODS: A secondary analysis of data obtained as part of a nationwide household survey between May 25 and June 14, 2015, was undertaken. Information obtained from women aged 21-65years was included. Multiple regression analyses were performed to identify factors associated with having undergone cervical smear testing. RESULTS: A total of 829 women were included. Among 816 women who answered the relevant survey question, 710 (87.0%) had no knowledge of cervical smear tests. Only 39 (4.7%) of the 829 women had ever undergone a cervical smear. In multivariate analysis, having undergone a cervical smear was associated with literacy (adjusted odds ratio [aOR] 3.26, 95% confidence interval [CI] 1.25-8.51; P=0.016) and living in rural areas (aOR 0.48, 95% CI 0.24-0.96; P=0.038). CONCLUSION: Nepali women rarely undergo cervical smear screening, with the lowest prevalence recorded among the illiterate and those living in rural areas. To boost screening rates, educational campaigns and rural outreach are needed.


Asunto(s)
Detección Precoz del Cáncer/métodos , Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/métodos , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Alfabetización , Modelos Logísticos , Persona de Mediana Edad , Análisis Multivariante , Nepal , Prevalencia , Población Rural , Encuestas y Cuestionarios , Adulto Joven
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