Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey.
OBJECTIVE
Little is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda.


METHODS
Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0-18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates.


RESULTS
Of 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths).


CONCLUSIONS
Although some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.
Department of Surgery, University of Washington, Seattle, WA, USA.
Elissa K
EK
Butler
Duke University Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
Tu M
TM
Tran
Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA.|Duke University School of Medicine, Durham, NC, USA.
Anthony T
AT
Fuller
Duke University School of Medicine, Durham, NC, USA.
Alexa
A
Brammell
Duke University Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.|Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA.
Joao Ricardo
JR
Vissoci
State University of West of Parana, Unioeste, Foz do Iguaçu, Brazil.|Public Health Research Group, Unioeste, Toledo, Brazil.
Luciano
L
de Andrade
Makerere University School of Public Health, Kampala, Uganda.
Fredrick
F
Makumbi
Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda.
Samuel
S
Luboga
Makerere University School of Public Health, Kampala, Uganda.
Christine
C
Muhumuza
Ministry of Health, Government of Uganda, Kampala, Uganda.
Vincent F
VF
Ssennono
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Jeffrey G
JG
Chipman
Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
Moses
M
Galukande
Duke University Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.|Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA.|Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Michael M
MM
Haglund
Duke University Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA. emily.smith1@duke.edu.|Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA. emily.smith1@duke.edu.
Emily R
ER
Smith
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D015995:Prevalence; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014454:Uganda
Community survey; Global surgery; Low- and middle-income countries; SOSAS; Sub-Saharan Africa