title: Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda.
abstract: BACKGROUND
  Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda.
  
  
  METHODS
  The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics.
  
  
  RESULTS
  A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8-43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3-16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6-7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services.
  
  
  CONCLUSIONS
  The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA. rtp3z@virginia.edu
authors.forename: Robin T
authors.initials: RT
authors.lastname: Petroze
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.forename: Francine
authors.initials: F
authors.lastname: Niyonkuru
authors.forename: Melissa
authors.initials: M
authors.lastname: Mallory
authors.forename: Edmond
authors.initials: E
authors.lastname: Ntaganda
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Joharifard
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Guterbock
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.forename: Patrick
authors.initials: P
authors.lastname: Kyamanywa
authors.forename: J Forrest
authors.initials: JF
authors.lastname: Calland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D003625:Data Collection; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology; D012959:Socioeconomic Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult