Allison F Linden1, Rebecca G Maine2, Bethany L Hedt-Gauthier3, Emmanual Kamanzi4, Kevin Gauvey-Kern5, Gita Mody6, Georges Ntakiyiruta7, Grace Kansayisa8, Edmond Ntaganda9, Francine Niyonkuru9, Joel Mubiligi4, Tharcisse Mpunga10, John G Meara11, Robert Riviello6. 1. Department of Surgery, Georgetown University Hospital, Washington, DC; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Electronic address: Alli.Linden@gmail.com. 2. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. 4. Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. 5. University of Maryland School of Medicine, Baltimore, MD. 6. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 7. Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda. 8. Rwanda Military Hospital, Kigali, Rwanda. 9. Centre Hospitalier Universitaire de Kigali (CHUK), Kigali, Rwanda. 10. Rwanda Ministry of Health, Butaro Hospital, Butaro, Rwanda. 11. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Abstract
BACKGROUND: Validated, community-based surveillance methods to monitor epidemiologic progress in surgery have not yet been employed for surgical capacity building. The goal of this study was to create and assess the validity of a community-based questionnaire collecting data on untreated surgically correctable disease throughout Burera District, Rwanda, to accurately plan for surgical services at a district hospital. METHODS: A structured interview to assess for 10 index surgically treatable conditions was created and underwent local focus group and pilot testing. Using a 2-stage cluster sampling design, Rwandan data collectors conducted the structured interview in 30 villages throughout the Burera District. Rwandan physicians revisited the surveyed households to perform physical examinations on all household members, used as the gold standard to validate the structured interview. RESULTS: A total of 2,990 individuals were surveyed and 2,094 (70%) were available for physical examination. The calculated sensitivity and specificity of the survey tool were 44.5% (95% CI, 38.9-50.2%) and 97.7% (95% CI, 96.9-98.3%), respectively. The conditions with the highest sensitivity and specificity were hydrocephalus, clubfoot, and injuries/infections. Injuries/infections and hernias/hydroceles were the conditions most frequently found on examination that were not reported during the interview. CONCLUSION: This study provides the first attempt to validate a community-based surgical surveillance tool. The finding of low sensitivity was likely related to limited access to care and poor health literacy. Accurate community-based surveys are critical to planning integrated health systems that include surgical care as a core component.
BACKGROUND: Validated, community-based surveillance methods to monitor epidemiologic progress in surgery have not yet been employed for surgical capacity building. The goal of this study was to create and assess the validity of a community-based questionnaire collecting data on untreated surgically correctable disease throughout Burera District, Rwanda, to accurately plan for surgical services at a district hospital. METHODS: A structured interview to assess for 10 index surgically treatable conditions was created and underwent local focus group and pilot testing. Using a 2-stage cluster sampling design, Rwandan data collectors conducted the structured interview in 30 villages throughout the Burera District. Rwandan physicians revisited the surveyed households to perform physical examinations on all household members, used as the gold standard to validate the structured interview. RESULTS: A total of 2,990 individuals were surveyed and 2,094 (70%) were available for physical examination. The calculated sensitivity and specificity of the survey tool were 44.5% (95% CI, 38.9-50.2%) and 97.7% (95% CI, 96.9-98.3%), respectively. The conditions with the highest sensitivity and specificity were hydrocephalus, clubfoot, and injuries/infections. Injuries/infections and hernias/hydroceles were the conditions most frequently found on examination that were not reported during the interview. CONCLUSION: This study provides the first attempt to validate a community-based surgical surveillance tool. The finding of low sensitivity was likely related to limited access to care and poor health literacy. Accurate community-based surveys are critical to planning integrated health systems that include surgical care as a core component.
Authors: Tu M Tran; Anthony T Fuller; Elissa K Butler; Christine Muhumuza; Vincent F Ssennono; Joao Ricardo Vissoci; Fredrick Makumbi; Jeffrey G Chipman; Moses Galukande; Michael M Haglund; Samuel Luboga Journal: Afr Health Sci Date: 2019-03 Impact factor: 0.927
Authors: Elissa K Butler; Tu M Tran; Anthony T Fuller; Christine Muhumuza; Sarah Williams; Joao R N Vissoci; Samuel Luboga; Michael M Haglund; Fredrick Makumbi; Moses Galukande; Jeffrey G Chipman Journal: Ann Glob Health Date: 2019-04-01 Impact factor: 2.462
Authors: Rebecca G Maine; Allison F Linden; Robert Riviello; Emmanuel Kamanzi; Gita N Mody; Georges Ntakiyiruta; Grace Kansayisa; Edmond Ntaganda; Francine Niyonkuru; Joel M Mubiligi; Tharcisse Mpunga; John G Meara; Bethany L Hedt-Gauthier Journal: JAMA Surg Date: 2017-12-20 Impact factor: 14.766
Authors: Ernest Muhirwa; Caste Habiyakare; Bethany L Hedt-Gauthier; Jackline Odhiambo; Rebecca Maine; Neil Gupta; Gabriel Toma; Theoneste Nkurunziza; Tharcisse Mpunga; Jeanne Mukankusi; Robert Riviello Journal: World J Surg Date: 2016-09 Impact factor: 3.352