title: Surgically avertable burden of digestive diseases at first-level hospitals in low and middle-income regions.
abstract: BACKGROUND
  To quantify the burden of digestive diseases avertable by surgical care at first-level hospitals in low- and middle-income countries (LMICs).
  
  
  METHODS
  We examined 4 digestive diseases from the Global Burden of Disease (GBD) 2010 STUDY: Appendicitis, intestinal obstruction, inguinal and femoral hernia, and gallbladder and bile duct disease. Using demographic and epidemiologic data from the GBD 2010 STUDY, we calculated the potential decrease in burden of digestive diseases if quality surgical services were available universally and accessible at first-level hospitals. The lowest case fatality rates for each age and sex grouping from all GBD regions were assumed to reflect the best possible state of full surgical coverage and treatment. These best scenario rates were applied to the GBD 2010 results from all LMIC regions to estimate surgically avertable burden.
  
  
  RESULTS
  Overall, 4.8 million disability-adjusted life-years (DALYs) or 65% of burden related to the 4 digestive diseases are avertable potentially with first-level surgical care in LMICs. Sub-Saharan Africa has the greatest avertable burden in absolute DALYs (1.7 million) and avertable proportion (83%). Intestinal obstruction accounted for the largest portion of avertable burden among the 4 digestive diseases (2.2 million DALYs; 64% avertable).
  
  
  CONCLUSIONS
  Improving the capacity of surgical services at first-level hospitals is essential for averting the burden of digestive diseases in LMICs. Practicable strategies for scaling up surgical capacities in rural districts are available potentially, which must be given due attention.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA; School of Population Health, University of Queensland, Brisbane, Queensland, Australia. Electronic address: higashi2@uw.edu.
authors.forename: Hideki
authors.initials: H
authors.lastname: Higashi
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Barendregt
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA; Division of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kassebaum
authors.affiliation: Department of Surgery, School of Medicine, Stanford University, Stanford, CA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
authors.affiliation: Department of Surgery, School of Medicine, University of California, San Diego, CA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bickler
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA; School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
mesh_terms: D017281:Cost of Illness; D004066:Digestive System Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D006761:Hospitals; D006801:Humans; D007182:Income