Skip to main content

Advertisement

SpringerLink
Log in

Injury, Disability and Access to Care in Rwanda: Results of a Nationwide Cross-Sectional Population Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Disparities in access to quality injury care are a growing concern worldwide, with over 90 % of global injury-related morbidity and mortality occurring in low-income countries. We describe the use of a survey tool that evaluates the prevalence of surgical conditions at the population level, with a focus on the burden of traumatic injuries, subsequent disabilities, and barriers to injury care in Rwanda.

Methods

The Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate surgical consultation or intervention. Questions are structured anatomically and designed around a representative spectrum of surgical conditions. Households in Rwanda were sampled using two-stage cluster sampling, and interviews were conducted over a one-month period in 52 villages nationwide, with representation of all 30 administrative districts. Injury-related results were descriptively analyzed and population-weighted by age and gender.

Results

A total of 1,627 households (3,175 individuals) were sampled; 1,185 lifetime injury-related surgical conditions were reported, with 38 % resulting in some form of perceived disability. Of the population, 27.4 % had ever had a serious injury-related condition, with 2.8 % having an injury-related condition at the time of interview. Over 30 % of household deaths in the previous year may have been surgically treatable, but only 4 % were injury-related.

Conclusions

Determining accurate injury and disability burden is crucial to health system planning in low-income countries. SOSAS is a useful survey for determining injury epidemiology at the community level, which can in turn help to plan prevention efforts and optimize provision of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128

    Article  PubMed  Google Scholar 

  2. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223

    Article  PubMed  Google Scholar 

  3. Chandran A, Hyder AA, Peek-Asa C (2010) The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev 32(1):110–120

    Article  PubMed Central  PubMed  Google Scholar 

  4. World Health Organization (2010) Injuries and violence: the facts. WHO, Geneva

    Google Scholar 

  5. World Health Organization (2011) World report on disability. WHO, Geneva

    Google Scholar 

  6. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144

    Article  PubMed  Google Scholar 

  7. Barnighausen T, Bloom DE, Humair S (2011) Going horizontal: shifts in funding of global health interventions. N Engl J Med 364(23):2181–2183

    Article  CAS  PubMed  Google Scholar 

  8. Debas H, Gosseln R, McCord C, Thind A (2006) Surgery. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M et al (eds) Disease control priorities in developing countries, 2nd edn. World Bank, Washington

    Google Scholar 

  9. Groen RS, Samai M, Stewart KA, Cassidy LD, Kamara TB, Yambasu SE et al (2012) Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 380(9847):1082–1087

    Article  PubMed  Google Scholar 

  10. Petroze RT, Groen RS, Niyonkuru F, Mallory M, Ntaganda E, Joharifard S et al (2013) Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery 153(4):457–464

    Article  PubMed  Google Scholar 

  11. World Bank (2012) http://www.data.worldbank.org

  12. National Institute of Statistics of Rwanda (NISR), Rwanda Ministry of Health (MOH), and ICF International (2011) Rwanda demographic and health survey 2010. NISR, MOH, and ICF International, Calverton

    Google Scholar 

  13. Lu C, Chin B, Lewandowski JL, Basinga P, Hirschhorn LR, Hill K et al (2012) Towards universal health coverage: an evaluation of Rwanda Mutuelles in its first eight years. PLoS One 7(6):e39282

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Petroze RT, Nzayisenga A, Rusanganwa V, Ntakiyiruta G, Calland JF (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443

    Article  CAS  PubMed  Google Scholar 

  15. McGee K, Sethi D, Peden M, Habibula S (2004) Guidelines for conducting community surveys on injuries and violence. Inj Control Saf Promot 11(4):303–306

    Article  PubMed  Google Scholar 

  16. Groen RS, Samai M, Petroze RT, Kamara TB, Yambasu SE, Calland JF et al (2012) Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg 36(4):771–774. doi:10.1007/s00268-012-1448-9

    Article  PubMed  Google Scholar 

  17. Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG (2009) Injuries: the neglected burden in developing countries. Bull World Health Organ 87(4):246

    Article  PubMed Central  PubMed  Google Scholar 

  18. Stewart KA, Groen RS, Kamara TB, Farahzad MM, Samai M, Cassidy LD et al (2013) Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone. JAMA Surg 148(5):463–469

    Article  PubMed Central  PubMed  Google Scholar 

  19. United Nations Development Programme (2011) Human development report 2011: sustainability and equity: a better future for all. Palgrave Macmillan, Basingstoke

    Google Scholar 

  20. Hyder AA (2013) Injuries in low- and middle-income countries: a neglected disease in global public health. Injury 44(5):479–480

    Article  Google Scholar 

  21. Mukhopadhyay B, Boniface R, Razek T (2009) Trauma in Tanzania: researching injury in a low-resource setting. Mcgill J Med 12(2):27

    PubMed Central  PubMed  Google Scholar 

  22. Kobusingye OC, Guwatudde D, Owor G, Lett RR (2002) Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev 8(2):133–136

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Navaratne KV, Fonseka P, Rajapakshe L, Somatunga L, Ameratunga S, Ivers R et al (2009) Population-based estimates of injuries in Sri Lanka. Inj Prev 15(3):170–175

    Article  CAS  PubMed  Google Scholar 

  24. Gilyoma JM, Mabula JB, Chalya PL (2013) Animal-related injuries in a resource-limited setting: experiences from a Tertiary health institution in northwestern Tanzania. World J Emerg Surg 8(1):7

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kobusingye O, Guwatudde D, Lett R (2001) Injury patterns in rural and urban Uganda. Inj Prev 7(1):46–50

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Atijosan O, Rischewski D, Simms V, Kuper H, Linganwa B, Nuhi A et al (2008) A national survey of musculoskeletal impairment in Rwanda: prevalence, causes and service implications. PLoS One 3(7):e2851

    Article  PubMed Central  PubMed  Google Scholar 

  27. Mock CN, nii-Amon-Kotei D, Maier RV (1997) Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 42(3):504–511 discussion 11–3

    Article  CAS  PubMed  Google Scholar 

  28. Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R et al (2009) First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS One 4(9):e6955

    Article  PubMed Central  PubMed  Google Scholar 

  29. Nafissi N, Saghafinia M, Balochi K (2008) Improving trauma care in rural Iran by training existing treatment chains. Rural Remote Health 8(4):881

    CAS  PubMed  Google Scholar 

  30. Mock CN, Tiska M, Adu-Ampofo M, Boakye G (2002) Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 53(1):90–97

    Article  PubMed  Google Scholar 

  31. Sun JH, Shing R, Twomey M, Wallis LA (2012) A strategy to implement and support pre-hospital emergency medical systems in developing, resource-constrained areas of South Africa. Injury 45(1):31–38

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Special thanks to Barbara Choo, Yue Li, Dave Morris, Dominique Habimana (NISR), Manasse Nzayirambaho (NUR School of Public Health), Center for Survey Research at UVA, Elias Nyandwi (CGIS), Rwanda Surgical Society, Faculty of Medicine at the National University of Rwanda, Rwandan Ministry of Health, and our student interviewers: Georges Gasana, Marie Grace Kansayisa, Theoneste Maniragaba, Achille Manirakiza, Yvette Ntaganda, Innocent Nzeyimana, Herman Rwambibi, Gallican Nshogoza Rwibasira, Chantal Uwamariya.

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

The study was conducted under the leadership of the Faculty of Medicine at the National University of Rwanda in Butare, Rwanda. Ethical approval was obtained from the University of Virginia Institutional Review Board for the Behavioral Sciences (#2011-0261-00), the Rwanda National Ethics Committee (#006/RNEC/2011), and the Rwanda National Institute of Statistics (#893/2011/10/NISR). Results were presented to the Rwandan Ministry of Health, the Rwandan National Institute of Statistics, the National University of Rwanda’s Directorate of Research, and the Rwanda Surgical Society before publication.

Funding

Surgeons OverSeas (SOS) provided the survey tool and technical assistance and funded the logistical execution of data collection.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22908, USA

    Robin T. Petroze & J. Forrest Calland

  2. School of Medicine - College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda

    Robin T. Petroze, Francine Niyonkuru, Edmond Ntaganda & Patrick Kyamanywa

  3. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Shahrzad Joharifard

  4. Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA

    Reinou S. Groen

  5. Surgeons OverSeas (SOS), New York, NY, USA

    Reinou S. Groen & Adam L. Kushner

  6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adam L. Kushner

  7. Department of Surgery, Columbia University, New York, NY, USA

    Adam L. Kushner

  8. Center for Survey Research & Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA

    Thomas M. Guterbock

Authors
  1. Robin T. Petroze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahrzad Joharifard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reinou S. Groen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francine Niyonkuru
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edmond Ntaganda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adam L. Kushner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas M. Guterbock
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Patrick Kyamanywa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Forrest Calland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Forrest Calland.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petroze, R.T., Joharifard, S., Groen, R.S. et al. Injury, Disability and Access to Care in Rwanda: Results of a Nationwide Cross-Sectional Population Study. World J Surg 39, 62–69 (2015). https://doi.org/10.1007/s00268-014-2544-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2544-9

Keywords

Search

Navigation