title: Prevalence of thoracic surgical care need in a developing country: results of a cluster-randomized, cross-sectional nationwide survey.
abstract: BACKGROUND
  Developing countries without established surgical capacity face heightened morbidity and mortality from poorly understood, untreated thoracic surgical impairments. This study sought to estimate the prevalence of thoracic surgical need in a low-income country and consider contributing factors involved.
  
  
  METHODS
  Cluster-randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool in Sierra Leone from January 9-February 3, 2012.
  
  
  RESULTS
  Data were collected and analyzed from 3645 respondents (response rate 98.3%). 273 (7.5%) reported ≥1 chest (including heart, lungs, and mediastinum) or breast surgical problem during their lifetime; 268 (7.4%) reported ≥1 back complaint. Multiple problems could be reported, resulting in a total of 277 chest/breast and 268 back complaints. The majority (184/545) were related to acquired deformities. Most occurred ≥12 months ago (364/545) and continued to impact the participant at the time of the interview (339/545). 322/545 sought care; however, 40% (130/322) did not receive care, predominately due to an inability to pay. Adjusted logistic regression found that chest/breast problems were more common among farm workers, older participants, and individuals with minimal education, while back problems were more common in the same groups and males.
  
  
  CONCLUSIONS
  The study provides data on the prevalence of thoracic surgical conditions and factors affecting prevalence in one of the world's poorest countries. The results speak to the need for further work to enhance health systems strengthening while offering the opportunity for future training and research in resource-limited settings--an area of thoracic surgery that is not well understood.
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School & Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA; Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. Electronic address: czogg@jhmi.edu.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Connaught Hospital, Tower Hill, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: Surgeons OverSeas (SOS), 505 East 5th Street, Suite 3E, New York, NY 10009, USA; Department of Gynecology & Obstetrics, The Johns Hopkins Hospital, 1650 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, 1650 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Surgeons OverSeas (SOS), 505 East 5th Street, Suite 3E, New York, NY 10009, USA; Department of Surgery, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, 1650 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000601:surgery; D002648:Child; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012807:Sierra Leone; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data*
keywords: Breast; Chest; International surgery; Surgical need; Thoracic surgery