Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, US.
Texas Tech University Health Sciences Center, Lubbock, US.
Ann Glob Health. 2019 Mar 14;85(1):35. doi: 10.5334/aogh.2340.
Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world's population receives approximately 73.6% of the world's total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators.
Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care.
One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0-40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%-13.5%).
This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India.
全球估计显示，有 50 亿人无法获得安全、优质和及时的外科护理。世界上最富有的三分之一人口接受了全球外科手术总量的约 73.6%，而最贫穷的三分之一人口仅接受了 3.5%。这项试点研究旨在通过外科医生海外评估手术需求（SOSAS）调查评估印度农村地区的外科疾病负担，并评估使用认证社会卫生活动家（ASHA）作为普查员的可行性。
2015 年 6 月至 7 月，在印度哈里亚纳邦的纳纳克布尔，在印度社区卫生工作者（称为 ASHA）的支持下，从 50 户家庭中收集数据。户主提供人口统计数据；两名家庭成员提供个人外科病史。当前手术需求定义为接受采访时存在的自我报告手术问题，而未满足的手术需求则定义为受访者未获得治疗的手术问题。
选定的所有家庭都参与了调查，共 93 人。28 人（30.1%；95%CI 21.0-40.5）表示他们在以下身体部位有当前的手术需求：2 例面部、1 例胸部/乳房、1 例背部、3 例腹部、4 例腹股沟/生殖器和 17 例四肢。6 人有未满足的手术需求（6.5%；95%CI 2.45%-13.5%）。
这项在纳纳克布尔的试点研究是 SOSAS 调查在印度的首次实施，表明存在重大的外科疾病负担。该研究表明，使用 ASHA 进行调查是可行的，为未来在全国范围内进行调查提供了 ASHA 项目的潜在用途。这些数据为进一步评估加强印度农村地区外科系统的干预措施提供了有用的初步证据，强调了这方面的必要性。
