title: Nationally representative household survey of surgery and mortality in Sierra Leone.
abstract: BACKGROUND
  There is limited evidence to characterize the burden of unmet need of surgical diseases in low- and middle-income countries. The purpose of this study was to determine rate of deaths attributable to a surgical condition and reasons for not seeking surgical care in Sierra Leone.
  
  
  METHODS
  The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a survey tool developed collaboratively to be used for cross-sectional data collection of the prevalence of surgical conditions in any country. A population-weighted cluster-sample household survey was conducted throughout Sierra Leone in 2012 using the SOSAS survey tool.
  
  
  RESULTS
  Total of 1,840 households (11,870 individuals) were sampled, yielding a 98.3 % response rate. Overall, there were 709 total deaths reported (6.0 %). The mean age at death was 36.4 ± 30.1 years: 330 (46.6 %) were female. Most deaths occurred at home (58.1 % vs. 34.1 % in hospitals). Of the 709 deaths, 237 (33.4 %) were associated with conditions included in our predefined surgical disease category. Abdominal distension/pain was the most commonly associated surgical condition (13.9 %) followed by perinatal bleeding/illness (6.0 %). Among the 237 with surgical conditions, 51 (21.9 %) did not seek medical care, most commonly because of a lack of money (35.3 %) or inability to provide timely care (37.3 %).
  
  
  CONCLUSIONS
  A large proportion of deaths in Sierra Leone was associated with surgical conditions, the majority of which did not undergo surgical intervention. Our results indicate that to remove barriers to effective surgical care in Sierra Leone policymakers should first focus on relieving financial burdens and increasing access to timely surgical care.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA. skwon11@uw.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.forename: Laura D
authors.initials: LD
authors.lastname: Cassidy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Samai
authors.forename: Sahr E
authors.initials: SE
authors.lastname: Yambasu
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012807:Sierra Leone / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult