Disease amenable to surgical intervention accounts for 11-15 % of world disability and there is increasing interest in surgery as a global public health issue. National HealthStrategic Plans (NHSPs) reflect countries' long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue inAfrica.NHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources.19 % of NHSPs had no mentionof surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets.NHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems. Read the full article here.
Background Trauma has become a worldwide pandemic. Without dedicated public health interventions, fatal injuries will rise 40% and become the 4th leading cause of death by 2030, with the burden highest in low-income and middle-income countries (LMICs). The aim of this study was to estimate the prevalence of traumatic injuries and injury-related deaths in low-resource countries worldwide, using population-based data from the Surgeons OverSeas Assessment of Surgical Need (SOSAS), a validated survey tool.
Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countriesby Global Musculoskeletal
Abstract: Background Surgical care needs in low-resource countries are increasingly recognised as an important aspect of global health, yet data for the size of the problem are insufficient. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a population-based cluster survey previously used in Nepal, Rwanda, and Sierra Leone. Methods Using previously published SOSAS data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of overall prevalence of surgically treatable conditions was estimated and the number of deaths that could have been avoided by providing access to surgical care was calculated for the broader community of low-resource countries. Such conditions included, but were not limited to, injuries (road traffic incidents, falls, burns, and gunshot or stab wounds), masses (solid or soft, reducible), deformities (congenital or acquired), abdominal distention, and obstructed delivery. Population and health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with a per capita health expenditure of US$100 or less annually. The overall prevalence estimate from the previously published SOSAS data was extrapolated to each low-resource country. Using crude death rates for each country and the calculated proportion of avoidable deaths, a total number of deaths possibly averted in the previous year with access to appropriate surgical care was calculated. Findings The overall prevalence of surgically treatable conditions was 11·16% (95% CI 11·15–11·17) and 25·6% (95% CI 25·4–25·7) of deaths were potentially avoidable by providing access to surgical care. Using these percentages for the 48 low-resource countries, an estimated 288·2 million people are living with a surgically treatable condition and 5·6 million deaths could be averted annually by the provision of surgical care. In the Nepal SOSAS study, the observed agreement between self-reported verbal responses and visual physical examination findings was 94·6%. Such high correlation helps to validate the SOSAS tool. Interpretation Hundreds of millions of people with surgically treatable conditions live in low-resource countries, and about 25% of the mortality annually could be avoided with better access to surgical care. Strengthening surgical care must be considered when strengthening health systems and in setting future sustainable development goals. Funding None.
Injury prevalence and causality in developing nations: Results from a countrywide population-based survey in Nepalby Global Musculoskeletal
Traumatic injury affects nearly 5.8 million people annually and causes 10% of the world's deaths. In this study we aimed to estimate injury prevalence, to describe risk-factors and mechanisms of injury, and to estimate the number of injury-related deaths in Nepal, a low-income South Asian country.
Traumatic injuries are an important cause of disability and mortality worldwide and more than 90% of injury-related deaths occur in low-income and middle-income countries. Despite its overall significance, little information exists about the burden of injuries in developing countries. We aim to estimate the prevalence of traumatic injuries, describe injury mechanisms, and assess the degree of associated disability in Sierra Leone.
The Key Informant Method (KIM) is is an approach to identifying children with disabilities in the community through trained community volunteers, known as Key Informants (KIs). KIM is an evolving method that has been used by ICED in a number of projects, supported by CBM.
Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawiby Global Musculoskeletal
Purpose: To develop a conceptual model representing the impact of musculoskeletal impairments (MSIs) in the lives of children in Malawi. Method: A total of 169 children with MSIs (CMSIs), family and other community members participated in 57 interviews, focus groups and observations. An inductive approach to data analysis was used to conceptualise the impact of MSIs in children’s day-to-day lives. Results: The main themes that emerged were Indignity, Exclusion, Pain and Hunger. Indignity represents various affronts to children’s sense of inherent equal worth as human beings, for example when bullied by peers. Exclusion refers to CMSIs being excluded from three core daily activities: school, play and household chores. Some CMSIs experienced Pain, for example as an outcome of striving to participate. Children with severe mobility impairments were at increased risk of Hunger, having less access to food outside the home and placing a burden of care on the family that could restrict household productivity. Household Poverty was therefore included in the model, as this household impact was inseparable from the impact on CMSIs. Conclusion: It is recommended that rehabilitation interventions are planned and evaluated with consideration to their impact on Exclusion, Indignity, Pain, Hunger and Household Poverty using multi-faceted partnerships.
A National Survey of Musculoskeletal Impairment in Rwanda: Prevalence, Causes and Service Implicationsby Global Musculoskeletal
Accurate information on the prevalence and causes of musculoskeletal impairment (MSI) is lacking in low income countries. We present a new survey methodology that is based on sound epidemiological principles and is linked to the World Health Organisation's International Classification of Functioning.
Objective: To estimate the global burden of low back pain (LBP).
Objective: Gout is the most common cause of inflammatory arthritis in men, but has not previously been included in Global Burden of Disease (GBD) studies. As part of the GBD 2010 Study, the Musculoskeletal Disorders and Risk Factors Expert Group estimated the global burden of gout.
The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 studyby Global Musculoskeletal
Objective: To estimate disability from the remainder of musculoskeletal (MSK) disorders (categorised as other MSK) not covered by the estimates made specifically for osteoarthritis (OA), rheumatoid arthritis (RA), gout, low back pain and neck pain, as part of the Global Burden of Disease (GBD) 2010 study.
The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 studyby Global Musculoskeletal
Objective: To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions.
Objectives: To estimate the global burden of rheumatoid arthritis (RA), as part of the Global Burden of Disease 2010 study of 291 conditions and how the burden of RA compares with other conditions.
The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It should be read in conjunction with the disease-specific MSK papers published in Annals of Rheumatic Diseases.
Objective: To estimate the global burden of neck pain.
Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the Global Burden of Disease 2010 Study and the next steps forwardby Global Musculoskeletal
The objective of this paper is to provide an overview of the strengths, limitations and lessons learned from estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Disease 2010 Study (GBD 2010 Study). It should be read in conjunction with the other GBD 2010 Study papers published in this journal. The strengths of the GBD 2010 Study include: the involvement of a MSK expert group; development of new and more valid case definitions, functional health states, and disability weights to better reflect the MSK conditions; the extensive series of systematic reviews undertaken to obtain data to derive the burden estimates; and the use of a new, more advanced version of the disease-modelling software (DisMod-MR). Limitations include: many regions of the world did not have data; the extent of heterogeneity between included studies; and burden does not include broader aspects of life, such as participation and well-being. A number of lessons were learned. Ongoing involvement of experts is critical to ensure the success of future efforts to quantify and monitor this burden. A paradigm shift is urgently needed among global agencies in order to alleviate the rapidly increasing global burden from MSK conditions. Prevention and control of MSK disability are required, along with health system changes. Further research is needed to improve understanding of the predictors and clinical course across different settings, and the ways in which MSK conditions can be better managed and prevented.
Reliable estimates of disease burden support rational allocation of financial and human resources. Measurement is a powerful force for change as 'what gets measured gets done'. The global burden of musculoskeletal disease studies ensures visibility of these highly prevalent, disabling diseases. Now we must act to reduce disease burden.