title: Injury, disability and access to care in Rwanda: results of a nationwide cross-sectional population study.
abstract: BACKGROUND
  Disparities in access to quality injury care are a growing concern worldwide, with over 90 % of global injury-related morbidity and mortality occurring in low-income countries. We describe the use of a survey tool that evaluates the prevalence of surgical conditions at the population level, with a focus on the burden of traumatic injuries, subsequent disabilities, and barriers to injury care in Rwanda.
  
  
  METHODS
  The Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate surgical consultation or intervention. Questions are structured anatomically and designed around a representative spectrum of surgical conditions. Households in Rwanda were sampled using two-stage cluster sampling, and interviews were conducted over a one-month period in 52 villages nationwide, with representation of all 30 administrative districts. Injury-related results were descriptively analyzed and population-weighted by age and gender.
  
  
  RESULTS
  A total of 1,627 households (3,175 individuals) were sampled; 1,185 lifetime injury-related surgical conditions were reported, with 38 % resulting in some form of perceived disability. Of the population, 27.4 % had ever had a serious injury-related condition, with 2.8 % having an injury-related condition at the time of interview. Over 30 % of household deaths in the previous year may have been surgically treatable, but only 4 % were injury-related.
  
  
  CONCLUSIONS
  Determining accurate injury and disability burden is crucial to health system planning in low-income countries. SOSAS is a useful survey for determining injury epidemiology at the community level, which can in turn help to plan prevention efforts and optimize provision of care.
authors.affiliation: Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22908, USA, rtp3z@virginia.edu.
authors.forename: Robin T
authors.initials: RT
authors.lastname: Petroze
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Joharifard
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.forename: Francine
authors.initials: F
authors.lastname: Niyonkuru
authors.forename: Edmond
authors.initials: E
authors.lastname: Ntaganda
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Guterbock
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; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D012017:Referral and Consultation; D012432:Rwanda / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult