title: Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries.
abstract: BACKGROUND
  The sequelae of acute musculoskeletal conditions, especially injuries and infections, are responsible for significant disability in low- and middle-income countries. This study characterizes the availability of selected musculoskeletal surgical services at different tiers of the health system in a convenience sample of 883 health facilities from 24 low- and lower-middle-income countries.
  
  
  METHODS
  Selected data points from the World Health Organization's (WHO) tool of situational analysis of surgical availability were extracted from the WHO's database in December, 2013. These included infrastructure, physical resources and supplies, interventions, and human resources. For a descriptive analysis, facilities were divided into two groups based on number of beds (<100, 100-300, and >300) and level of facility (primary referral, secondary/tertiary, and Private/NGO/Mission). Statistical comparison was made between public and Private/NGO/Mission facilities based on number of beds (≤100, 100-300, and >300) using a Chi-Square analysis, with statistical significance at p < 0.05.
  
  
  RESULTS
  Significant deficiencies were noted in infrastructure, physical resources and supplies, and human resources for the provision of essential orthopedic surgical services at all tiers of the health system. Availability was significantly lower in public versus Private/NGO/Mission facilities for nearly all categories in facilities with ≤100 beds, and in a subset of measures in facilities with between 100 and 300 beds.
  
  
  CONCLUSIONS
  Deficiencies in the availability of orthopedic surgical services were observed at all levels of health facility and were most pronounced at facilities with ≤100 beds in the public sector. Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if we are to reduce the burden of death and disability from a variety of emergent health conditions.
  
  
  BACKGROUND
  There were no sources of funding.
authors: Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19106, USA, spiegeld@email.chop.edu.
authors: D A
authors: DA
authors: Spiegel
authors: A
authors: A
authors: Nduaguba
authors: M N
authors: MN
authors: Cherian
authors: M
authors: M
authors: Monono
authors: E T
authors: ET
authors: Kelley
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D006295:Health Resources / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity; D006761:Hospitals; D006801:Humans; D009983:Orthopedic Equipment / Q000600:supply & distribution*; D019637:Orthopedic Procedures; D009985:Orthopedics; D000078329:Workforce