E. K. Butler1, T. Tran2, A. Fuller2,3, F. Makumbi5, S. Luboga7, S. Kisakye5, M. Haglund2,9, J. Chipman10, M. Galukande11 1University Of Minnesota,Medical School,Minneapolis, MN, USA 2Duke University Medical Center,Global Health Institute,Durham, NC, USA 3Duke University Medical Center,Medical School,Durham, NC, USA 5Makerere University,School Of Public Health,Kampala, , Uganda 7Makerere University,Department Of Anatomy,Kampala, , Uganda 9Duke University Medical Center,Division Of Neurosurgery,Durham, NC, USA 10University Of Minnesota,Department Of Surgery,Minneapolis, MN, USA 11Makerere University,Department Of Surgery,Kampala, , Uganda
Introduction: Low- and middle-income countries are challenged by the dual burden of infectious and non-communicable diseases, including those requiring surgical care. Globally, it is estimated that 11% of all disability adjusted life-years lost result from conditions requiring surgery, however little is known about country or disease specific burden. We piloted a household-based survey to assess the burden of surgical conditions in a large peri-urban district of Uganda to estimate the population prevalence of surgical conditions and to identify logistical challenges of such a survey.
Methods: A total of 55 households in 5 randomly selected enumeration areas in the peri-urban district of Wakiso, Uganda were systematically sampled to complete the Surgeons OverSeas Assessment of Surgical Need survey. The head of household completed demographic and recent household death information, and 2 randomly selected individuals in each household completed a head-to-toe questionnaire on possible surgical conditions. The current and lifetime prevalence of surgical conditions and the proportion of recent household deaths that could be attributed to surgery were determined.
Results: Eight of 96 participants (8.3%) had an existing surgical condition, 6 of whom were currently in need of surgical care. The lifetime prevalence of surgical conditions was 28% (27/96) and 26% (7/27) of those individuals had some degree of disability due to their condition. The most common barrier to access to care was lack of financial resources. Two of 3 household deaths were surgically associated. The average time required to complete each household survey was 36 minutes. The main challenges were efficient coordination with local team members and government officials for completion of enumeration areas and language barriers.
Conclusion: This pilot study in a peri-urban district in Uganda showed a similar prevalence of surgical conditions compared to previous implementations of this survey in Rwanda and Sierra Leone. There were a limited number of addressable challenges in implementation of the pilot. A complete, nationwide study to assess the burden of surgical conditions is both feasible and necessary to further characterize the met and unmet need for surgical care in Uganda.