目标:目前,在中低收入国家(LMICs),没有一项可在全国范围内实施的调查来确定家庭一级的手部和上肢状况负担.这项研究描述了一种随机的聚类调查方法,该方法使用外科医生海外手术需求评估(SOSAS)调查来估计四个LMIC的手部和上肢状况负担。此外,这项研究确定了与多国层面未满足手术需求反应相关的因素.
方法:SOSAS仪器是一个随机分组的,横截面,全国范围内对尼泊尔管理的家庭进行调查,卢旺达,塞拉利昂,乌干达从2011年到2014年。我们确定了全国社会人口趋势,解剖,条件类型,机制,患病率,主观残疾,以及上肢调查反应的护理障碍。多变量模型确定了与四个国家未满足的上肢需求相关的因素。
结果:在四个国家/地区,13,763人参与了调查,确定了883例上肢状况(占所有手术状况的7.4%)。骨折伴有许多损伤(32.3%)。虽然大多数条件是获得的,先天性疾病占所有病因的11%。总的来说,明火/爆炸是最常见的机制(22.9%)。卢旺达人寻求护理(91.0%)和接受护理(88.6%)的比例最高。塞拉利昂表示寻求和接受护理最少(71%和63%,分别)。慢性损伤与接受护理显著相关,而文盲和主观残疾恶化是接受护理的障碍。
结论:在这项来自四个LMIC的上肢状况调查中,上肢状况主要由火灾/爆炸引起,许多人报告说骨折。文盲和更多的残疾状况使接受护理的几率降低了30%至40%,分别。
结论:SOSAS调查可能提供一种可重复的方法来评估相似LMIC中未满足的上肢护理需求。
OBJECTIVE: Currently, no nationally implementable survey exists to identify the burden of hand and upper extremity conditions at the household level in low-middle income countries (LMICs). This study describes a randomized cluster survey approach to estimating the burden of hand and upper extremity conditions in four LMICs using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey. Additionally, this study identifies factors associated with responses of unmet surgical need at the multinational level.
METHODS: The SOSAS instrument is a cluster-randomized, cross-sectional, countrywide survey of households administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. We identified nationwide trends for sociodemographic, anatomic, condition type, mechanism, prevalence, subjective disability, and barriers to care for upper extremity survey responses. A multivariable model identified factors associated with unmet upper extremity need across the four nations.
RESULTS: Across the four countries, 13,763 individuals participated in the survey, with 883 conditions of the upper extremity identified (7.4% of all surgical conditions surveyed). Fractures accompanied many of the injuries (32.3%). Although most conditions were acquired, congenital conditions comprised 11% of all etiologies. Overall, open fire/explosion was the most common mechanism (22.9%). Rwandans had the highest proportion of individuals seeking care (91.0%) and receiving care (88.6%). Sierra Leone indicated the fewest seeking and receiving care (71% and 63%, respectively). Chronic injuries were significantly associated with receiving care, whereas illiteracy and worsening subjective disability were barriers to receiving care.
CONCLUSIONS: In this survey of upper extremity conditions from four LMICs, upper extremity conditions primarily resulted from fire/explosions, and many reported sustaining a fracture. Illiteracy and more disabling conditions decreased the odds of receiving care by 30% to 40%, respectively.
CONCLUSIONS: The SOSAS survey may provide a reproducible means to evaluate the unmet need for upper extremity care across similar LMICs.