title: Musculoskeletal disease in Nepal: A countrywide cross-sectional survey on burden and surgical access.
abstract: BACKGROUND
  Musculoskeletal disease (MSD) is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in low and middle-income countries (LMICs) are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure incidence and prevalence of surgically treatable conditions, including MSD, in patients in LMICs.
  
  
  METHODS
  A countrywide survey was done in Nepal using SOSAS in May-June 2014. Clusters were chosen based on population weighted random sampling. Chi squared tests and multivariate logistic regression assessed associations between demographic variables and MSD.
  
  
  RESULTS
  Self-reported MSDs were seen in 14.8% of survey respondents with an unmet need of 60%. The majority of MSDs (73.9%) occurred between 1 and 12 months prior to the survey. Female sex (OR = 0.6; p < 0.000), access to motorized transport (for secondary facility, OR = 0.714; p < 0.012), and access to a tertiary health facility (OR = 0.512; p < 0.008) were associated with lower odds of MSD.
  
  
  CONCLUSIONS
  Based on this study, there are approximately 2.35 million people living with MSDs in Nepal. As the study identified non-availability, lack of money, and fear and/or lack of trust as the major barriers to orthopedic care in Nepal, future work should consider interventions to address these barriers.
  
  
  CONCLUSIONS
  There is a need to increase surgical capacity in LMICs; in particular, there is a need to bolster trauma and orthopedic care. Previous studies have suggested ways to allocate resources to build capacity. We recommend targeting the alleviation of these identified barriers in parallel with capacity building.
authors: Mayo Medical School, Rochester, MN, 55905, USA. Electronic address: sagarschawla@gmail.com.
authors: Sagar S
authors: SS
authors: Chawla
authors: BP Koirala Institue of Health Sciences, Dharan, Nepal. Electronic address: subratkhanal033@gmail.com.
authors: Subrat
authors: S
authors: Khanal
authors: BP Koirala Institue of Health Sciences, Dharan, Nepal. Electronic address: pranitaghimire690@gmail.com.
authors: Pranita
authors: P
authors: Ghimire
authors: Department of Surgery, Johns Hopkins University School of Medicine Baltimore, MD, 21287, USA. Electronic address: nnagara2@jhu.edu.
authors: Neeraja
authors: N
authors: Nagarajan
authors: University of California, San Francisco - East Bay, 1411 East 31st Street, Oakland, CA, 94602, USA; Surgeons OverSeas, New York, USA. Electronic address: shailvi.gupta@gmail.com.
authors: Shailvi
authors: S
authors: Gupta
authors: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. Electronic address: vvarada2@jhu.edu.
authors: Varshini
authors: V
authors: Varadaraj
authors: Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
authors: Benedict C
authors: BC
authors: Nwomeh
authors: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA; Surgeons OverSeas, New York, USA.
authors: Adam L
authors: AL
authors: Kushner
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D009390:Nepal / Q000453:epidemiology; D009985:Orthopedics / Q000706:statistics & numerical data*; D015995:Prevalence; D057566:Self Report; D012737:Sex Factors
keywords: Essential surgery; Low- and middle-income countries; Musculoskeletal disease; Nepal; Orthopedic surgery; Surgical capacity