Surgeons OverSeas, New York, NY 10003, USA.
Lancet. 2012 Sep 22;380(9847):1082-7. doi: 10.1016/S0140-6736(12)61081-2. Epub 2012 Aug 14.
Surgical care is increasingly recognised as an important part of global health yet data for the burden of surgical disease are scarce. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) was developed to measure the prevalence of surgical conditions and surgically treatable deaths in low-income and middle-income countries. We administered this survey countrywide in Sierra Leone, which ranks 180 of the 187 nations on the UN Development Index.
The study was done between Jan 9 and Feb 3, 2012. 75 of 9671 enumeration areas, the smallest administrative units in Sierra Leone, were randomly selected for the study clusters, with a probability proportional to the population size. In each cluster 25 households were randomly selected to take part in the survey. Data were collected via handheld tablets by trained local medical and nursing students. A household representative was interviewed to establish the number of household members (defined as those who ate from the same pot and slept in the same structure the night before the interview), identify deaths in the household during the previous year, and establish whether any of the deceased household members had a condition needing surgery in the week before death. Two randomly selected household members underwent a head-to-toe verbal examination and need for surgical care was recorded on the basis of the response to whether they had a condition that they believed needed surgical assessment or care.
Of the 1875 targeted households, data were analysed for 1843 (98%). 896 of 3645 (25%; 95% CI 22·9-26·2) respondents reported a surgical condition needing attention and 179 of 709 (25%; 95% CI 22·5-27·9) deaths of household members in the previous year might have been averted by timely surgical care.
Our results show a large unmet need for surgical consultations in Sierra Leone and provide a baseline against which future surgical programmes can be measured. Additional surveys in other low-income and middle-income countries are needed to document and confirm what seems to be a neglected component of global health.
Surgeons OverSeas, Thompson Family Foundation.
外科护理越来越被认为是全球卫生的重要组成部分，但有关外科疾病负担的数据却很少。外科医生海外手术需求评估（SOSAS）旨在衡量中低收入国家的外科疾病患病率和可通过手术治疗的死亡人数。我们在塞拉利昂全国范围内开展了这项调查，塞拉利昂在联合国发展指数的 187 个国家中排名第 180。
这项研究于 2012 年 1 月 9 日至 2 月 3 日进行。从塞拉利昂 9671 个普查区中随机抽取了 75 个普查区作为研究单位，每个单位的选择概率与人口规模成正比。在每个单位中，随机抽取 25 户家庭参与调查。数据由经过培训的当地医学生和护士使用手持平板电脑收集。通过访谈一个家庭代表，确定家庭人数（定义为前一天晚上一起吃饭和睡在同一个地方的家庭成员），调查前一年家中的死亡人数，并确定前一周是否有任何已故家庭成员患有需要手术的疾病。从随机选择的两名家庭成员中进行从头到脚的口头检查，并根据他们是否患有他们认为需要手术评估或治疗的疾病来记录是否需要手术治疗。
在 1875 户目标家庭中，对 1843 户家庭（98%）进行了数据分析。3645 名受访者中有 896 名（25%；95%CI 22.9-26.2）报告有需要关注的外科疾病，而前一年家中 709 名死者中有 179 名（25%；95%CI 22.5-27.9）本可以通过及时的外科护理得到挽救。
我们的研究结果表明，塞拉利昂有大量未满足的外科咨询需求，为未来的外科项目提供了一个基准。需要在其他中低收入国家进行更多的调查，以记录和证实全球卫生中似乎被忽视的一个组成部分。
海外外科医生、汤普森家庭基金会。
