Sagar S Chawla1, Subrat Khanal2, Pranita Ghimire3, Neeraja Nagarajan4, Shailvi Gupta5, Varshini Varadaraj6, Benedict C Nwomeh7, Adam L Kushner8. 1. Mayo Medical School, Rochester, MN, 55905, USA. Electronic address: sagarschawla@gmail.com. 2. BP Koirala Institue of Health Sciences, Dharan, Nepal. Electronic address: subratkhanal033@gmail.com. 3. BP Koirala Institue of Health Sciences, Dharan, Nepal. Electronic address: pranitaghimire690@gmail.com. 4. Department of Surgery, Johns Hopkins University School of Medicine Baltimore, MD, 21287, USA. Electronic address: nnagara2@jhu.edu. 5. University of California, San Francisco - East Bay, 1411 East 31st Street, Oakland, CA, 94602, USA; Surgeons OverSeas, New York, USA. Electronic address: shailvi.gupta@gmail.com. 6. Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. Electronic address: vvarada2@jhu.edu. 7. Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA. 8. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA; Surgeons OverSeas, New York, USA.
Abstract
INTRODUCTION: Musculoskeletal disease (MSD) is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in low and middle-income countries (LMICs) are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure incidence and prevalence of surgically treatable conditions, including MSD, in patients in LMICs. METHODS: A countrywide survey was done in Nepal using SOSAS in May-June 2014. Clusters were chosen based on population weighted random sampling. Chi squared tests and multivariate logistic regression assessed associations between demographic variables and MSD. RESULTS: Self-reported MSDs were seen in 14.8% of survey respondents with an unmet need of 60%. The majority of MSDs (73.9%) occurred between 1 and 12 months prior to the survey. Female sex (OR = 0.6; p < 0.000), access to motorized transport (for secondary facility, OR = 0.714; p < 0.012), and access to a tertiary health facility (OR = 0.512; p < 0.008) were associated with lower odds of MSD. DISCUSSION: Based on this study, there are approximately 2.35 million people living with MSDs in Nepal. As the study identified non-availability, lack of money, and fear and/or lack of trust as the major barriers to orthopedic care in Nepal, future work should consider interventions to address these barriers. CONCLUSION: There is a need to increase surgical capacity in LMICs; in particular, there is a need to bolster trauma and orthopedic care. Previous studies have suggested ways to allocate resources to build capacity. We recommend targeting the alleviation of these identified barriers in parallel with capacity building.
INTRODUCTION:Musculoskeletal disease (MSD) is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in low and middle-income countries (LMICs) are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure incidence and prevalence of surgically treatable conditions, including MSD, in patients in LMICs. METHODS: A countrywide survey was done in Nepal using SOSAS in May-June 2014. Clusters were chosen based on population weighted random sampling. Chi squared tests and multivariate logistic regression assessed associations between demographic variables and MSD. RESULTS: Self-reported MSDs were seen in 14.8% of survey respondents with an unmet need of 60%. The majority of MSDs (73.9%) occurred between 1 and 12 months prior to the survey. Female sex (OR = 0.6; p < 0.000), access to motorized transport (for secondary facility, OR = 0.714; p < 0.012), and access to a tertiary health facility (OR = 0.512; p < 0.008) were associated with lower odds of MSD. DISCUSSION: Based on this study, there are approximately 2.35 million people living with MSDs in Nepal. As the study identified non-availability, lack of money, and fear and/or lack of trust as the major barriers to orthopedic care in Nepal, future work should consider interventions to address these barriers. CONCLUSION: There is a need to increase surgical capacity in LMICs; in particular, there is a need to bolster trauma and orthopedic care. Previous studies have suggested ways to allocate resources to build capacity. We recommend targeting the alleviation of these identified barriers in parallel with capacity building.
Authors: Arjan J Knulst; Shailvi Gupta; Reinou S Groen; Dipak Maharjan; Amatya S Kapendra; Jenny Dankelman; Adam L Kushner Journal: Trop Med Int Health Date: 2019-08-06 Impact factor: 2.622
Authors: Daniella M Cordero; Theodore A Miclau; Alexandra V Paul; Saam Morshed; Theodore Miclau; Claude Martin; David W Shearer Journal: OTA Int Date: 2020-04-23