title: Validation of a community-based survey assessing nonobstetric surgical conditions in Burera District, Rwanda.
abstract: BACKGROUND
  Validated, community-based surveillance methods to monitor epidemiologic progress in surgery have not yet been employed for surgical capacity building. The goal of this study was to create and assess the validity of a community-based questionnaire collecting data on untreated surgically correctable disease throughout Burera District, Rwanda, to accurately plan for surgical services at a district hospital.
  
  
  METHODS
  A structured interview to assess for 10 index surgically treatable conditions was created and underwent local focus group and pilot testing. Using a 2-stage cluster sampling design, Rwandan data collectors conducted the structured interview in 30 villages throughout the Burera District. Rwandan physicians revisited the surveyed households to perform physical examinations on all household members, used as the gold standard to validate the structured interview.
  
  
  RESULTS
  A total of 2,990 individuals were surveyed and 2,094 (70%) were available for physical examination. The calculated sensitivity and specificity of the survey tool were 44.5% (95% CI, 38.9-50.2%) and 97.7% (95% CI, 96.9-98.3%), respectively. The conditions with the highest sensitivity and specificity were hydrocephalus, clubfoot, and injuries/infections. Injuries/infections and hernias/hydroceles were the conditions most frequently found on examination that were not reported during the interview.
  
  
  CONCLUSIONS
  This study provides the first attempt to validate a community-based surgical surveillance tool. The finding of low sensitivity was likely related to limited access to care and poor health literacy. Accurate community-based surveys are critical to planning integrated health systems that include surgical care as a core component.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. Electronic address: Alli.Linden@gmail.com.
authors.forename: Allison F
authors.initials: AF
authors.lastname: Linden
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Maine
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Hedt-Gauthier
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Emmanual
authors.initials: E
authors.lastname: Kamanzi
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gauvey-Kern
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Gita
authors.initials: G
authors.lastname: Mody
authors.affiliation: Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.
authors.forename: Georges
authors.initials: G
authors.lastname: Ntakiyiruta
authors.affiliation: Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Grace
authors.initials: G
authors.lastname: Kansayisa
authors.affiliation: Centre Hospitalier Universitaire de Kigali (CHUK), Kigali, Rwanda.
authors.forename: Edmond
authors.initials: E
authors.lastname: Ntaganda
authors.affiliation: Centre Hospitalier Universitaire de Kigali (CHUK), Kigali, Rwanda.
authors.forename: Francine
authors.initials: F
authors.lastname: Niyonkuru
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Joel
authors.initials: J
authors.lastname: Mubiligi
authors.affiliation: Rwanda Ministry of Health, Butaro Hospital, Butaro, Rwanda.
authors.forename: Tharcisse
authors.initials: T
authors.lastname: Mpunga
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Riviello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance / Q000379:methods*; D012040:Regional Health Planning / Q000379:methods*; D012432:Rwanda; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D055815:Young Adult