title: Rectal bleeding and endoscopy need in Sierra Leone: results of a nationwide, community-based survey.
abstract: BACKGROUND
  Low-income and middle-income countries (LMICs) face a large burden of gastrointestinal diseases that benefit from prompt endoscopic diagnosis and treatment. This study aimed to estimate the prevalence of gross rectal bleeding among adults in Sierra Leone.
  
  
  METHODS
  A cluster randomised, cross-sectional household survey using the SOSAS tool was undertaken in Sierra Leone. 75 clusters of 25 households with two randomly selected respondents in each were sampled to estimate the prevalence of and disability from rectal bleeding. Barriers to care were also assessed.
  
  
  RESULTS
  3645 individuals responded to the survery, 15 with rectal bleeding. Nine responders (64%) had been bleeding for more than a year. The prevalence of rectal bleeding was 412 per 100 000 people. In view of these findings, an estimated 24 604 individuals with rectal bleeding are in need of evaluation in Sierra Leone. Eight (53%) of the 15 people with rectal bleeding sought care from a traditional healer. If medical care was not sought, the most common reason was absence of financial resources (ten people; 77%), followed by no capable facility availability (two; 15%), and inability to leave work or family for the time needed (one; 8%). Seven (54%) of those with rectal bleeding reported some form of disability, including five (39%) that had bleeding that prevented usual work.
  
  
  CONCLUSIONS
  The high prevalence of rectal bleeding identified in Sierra Leone represents a major unmet health-care need. This study did not examine the cause of bleeding. However, the high prevalence, chronicity, and disability among respondents with bleeding suggest a substantial burden of disease. Additionally, because microscopic haematochezia was not assessed, these data represent a bare-minimum estimate of rectal bleeding in need of evaluation and treatment. In view of the substantial burden of conditions that can be diagnosed, treated, or palliated with timely endoscopic therapy, it is appropriate to consider endoscopy among efforts to develop health system capacity in LMICs.
  
  
  BACKGROUND
  Surgeons OverSeas, the Thompson Family Foundation, and the Fogarty International Center.
authors: Department of Surgery, University of Washington, Washington, USA. Electronic address: stewarb@uw.edu.
authors: Barclay T
authors: BT
authors: Stewart
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Reinou S
authors: RS
authors: Groen
authors: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors: Thaim B
authors: TB
authors: Kamara
authors: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Steve
authors: S
authors: Kwon
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: T Peter
authors: TP
authors: Kingham
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA.
authors: Adam L
authors: AL
authors: Kushner