title: Unmet surgical needs in children: a household survey in Nepal.
abstract: OBJECTIVE
  While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low- and middle-income countries. Our study aims to assess pediatric surgical needs in Nepal.
  
  
  METHODS
  A countrywide cross-sectional study was performed in 15 randomly chosen districts; 3 clusters (2 rural; 1 urban) per district were selected. The prevalence of surgical conditions, unmet surgical needs, and barriers to care were analyzed among children (0-18 years of age).
  
  
  RESULTS
  Overall, 1,350 households and 2,695 individuals were surveyed (response rate: 97 %); 800 respondents (29.7 %, 95 % CI 27.9-31.4 %) were pediatric; 59.8 % (95 % CI 56.3-63.2 %) were male; median age was 10 years (IQR 5-15). Of them, 84 (10.5 %, 95 % CI 8.5-12.8 %) had a surgical condition; 48 (6.0 %, 95 % CI 4.5-7.9 %) reported an unmet need for surgical care. Based on this, we estimate that 706,076 (95 % CI 529,557-929,666) children live with untreated surgical conditions. Barriers to care included limited availability of services (31.3 %), funds (22.9 %), time (4.2 %), and fear/mistrust of medical services (16.7 %).
  
  
  CONCLUSIONS
  Close to 700,000 children in Nepal are estimated to need surgical consultation. Programs to address this should be developed alongside efforts by policy makers and donors to rectify the lack of care, bolster limited funds, and strengthen healthcare systems.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA, nnagara2@jhu.edu.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.forename: Sunil
authors.initials: S
authors.lastname: Shresthra
authors.forename: Varshini
authors.initials: V
authors.lastname: Varadaraj
authors.forename: Sagar
authors.initials: S
authors.lastname: Devkota
authors.forename: Anju
authors.initials: A
authors.lastname: Ranjit
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009390:Nepal; D011634:Public Health