title: Backlog and burden of fractures in Sierra Leone and Nepal: Results from nationwide cluster randomized, population-based surveys.
abstract: BACKGROUND
  The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e., a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or premature death; DALYs) in Sierra Leone and Nepal.
  
  
  METHODS
  Data from nationwide, cluster-randomized, community-based surveys of surgical need in Sierra Leone and Nepal were used to model the incidence and prevalence of fractures stratified by met and unmet needs. DALYs incurred from treated and untreated fractures were estimated. Additionally, the investment necessary to eliminate avertable incident fracture DALYs was modeled through 2025 using published cost per DALY averted estimates.
  
  
  RESULTS
  The incidence of treated and untreated fractures in Sierra Leone was 570 and 1004 fractures per 100,000 persons, respectively. There could be more than 2 million avertable fracture DALYs by 2025 in Sierra Leone and 2.5 million in Nepal requiring an estimated US$ 4,049,932 (range US$ 2,011,500-6,088,364) and US$ 4,962,402 (range US$ 2,464,701-7,460,103) to address this excess burden, respectively.
  
  
  CONCLUSIONS
  This study identified a significant burden of untreated fractures in both countries, and an opportunity to avert more than 4.5 million DALYs in 10 years in a cost-effective manner. Prioritizing funding mechanisms for orthopaedic care and implants should be considered given the large burden of untreated fractures found in both countries and the long-term savings and functional benefit from properly treated fractures.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: stewarb@uw.edu.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: 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.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: Department of Surgery, Nepal Medical College, Kathmandu, Nepal.
authors.forename: Sunil
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Nwomeh
authors.affiliation: School of Public Health, University of California, Berkeley, CA, USA; Institute for Global Orthopedics and Traumatology, Orthopaedic Department, University of California, San Francisco, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Gosselin
authors.affiliation: Division of Orthopedic Surgery, Children's Hospital of Philadelphia, PA, USA; Hospital and Rehabilitation Centre for Disabled Children, Janagal, Banepa, Kavre, Nepal.
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology*; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012807:Sierra Leone / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Capacity; Cost; DALY; Epidemiology; Orthopedic