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World Neurosurg. 2018 Feb;110:e747-e754. doi: 10.1016/j.wneu.2017.11.099. Epub 2017 Nov 24.

Prevalence of Surgically Untreated Face, Head, and Neck Conditions in Uganda: A Cross-Sectional Nationwide Household Survey.

Author information

1
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA.
2
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
3
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA.
4
Department of Surgery, University of Washington, Seattle, Washington, USA.
5
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University Global Health Institute, Duke University Medical Center, Durham, North Carolina, USA.
6
State University of West of Parana, Unioeste, Foz do Iguaçu, Brazil; Public Health Research Group, Unioeste, Toledo, Brazil.
7
Makerere University School of Public Health, Kampala, Uganda.
8
Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda.
9
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Makerere University School of Public Health, Kampala, Uganda.
10
Ministry of Health, Government of Uganda, Kampala, Uganda.
11
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
12
Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
13
Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: michael.haglund@duke.edu.

Abstract

BACKGROUND:

The Surgeons OverSeas Assessment of Surgical Need tool (SOSAS) was created to evaluate the burden of surgically treatable conditions in low- and middle-income countries. The goal of our study is to describe the face, head, and neck (FHN) conditions that need surgical care in Uganda, along with barriers to that care and disability from these conditions.

METHODS:

A 2-stage cluster randomized SOSAS survey was administered in a cross-sectional manner between August and September 2014. Participants included randomly selected persons in 105 enumeration areas in 74 districts throughout Uganda with 24 households in each cluster. The SOSAS survey collected demographic and clinical data on all respondents. Univariate and multivariate logistic models evaluated associations of demographic characteristics and clinical characteristics of the FHN conditions and outcomes of whether health care was sought or surgical care was received.

RESULTS:

Of the 4428 respondents, 331 (7.8%) reported having FHN conditions. The most common types of conditions were injury-related wounds. Of those who reported an FHN condition, 36% reported receiving no surgical care whereas 82.5% reported seeking health care. In the multivariate model, literacy and type of condition were significant predictors of seeking health care whereas village type, literacy, and type of condition remained significant predictors of receiving surgical care.

CONCLUSIONS:

Many individuals in Uganda are not receiving surgical care and barriers include costs, rural residency, and literacy. Our study highlights the need for targeted interventions in various parts of Uganda to increase human resources for surgery and expand surgical capacity.

KEYWORDS:

Disease burden; Global surgery; Head and neck injury; Low- and middle-income countries

PMID:
29180091
DOI:
10.1016/j.wneu.2017.11.099
[Indexed for MEDLINE]

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