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Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data

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Abstract

Background

Globally, a staggering five billion people lack access to adequate surgical care. Sub-Saharan Africa represents one of the regions of greatest need. We sought to understand how geographic factors related to unmet surgical need (USN) in Uganda.

Methods

We performed a geographic information system analysis of a nationwide survey on surgical conditions performed in 105 enumeration areas (EAs) representing the national population. At the district level, we determined the spatial autocorrelation of the following study variables: prevalence of USN, hub distance (distance from EA to the nearest surgical center), area of coverage (geographic catchment area of each center), tertiary facility transport time (average respondent-reported travel time), and care availability (rate of hospital beds by population and by district). We then used local indicators of spatial association (LISA) and spatial regression to identify any significant clustering of these study variables among the districts.

Results

The survey enumerated 4248 individuals. The prevalence of USN varied from 2.0–45 %. The USN prevalence was highest in the Northern and Western Regions. Moran’s I bivariate analysis indicated a positive correlation between USN and hub distance (p = 0.03), area of coverage (p = 0.02), and facility transport time (p = 0.03). These associations were consistent nationally. The LISA analysis showed a high degree of clustering among sets of districts in the Northern Sub-Region.

Conclusions

This study demonstrates a statistically significant association between USN and the geographic variables examined. We have identified the Northern Sub-Region as the highest priority areas for financial investment to reduce this unmet surgical disease burden.

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Acknowledgments

We thank the Uganda Bureau of Statistics for methodological advice and for providing randomized EAs and the Uganda Ministry of Health and Makerere College of Health Sciences for institutional support. We thank the following enumerators and field supervisors for their dedication to data quality and the field supervisors for their leadership of implementation: Samuel Kagongwe, Mark Kashaija, Sheila Kisakye, Mable Luzze, and Hassard Sempeera. We benefitted from the generous collaboration of the Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health, specifically Professors Scott Radloff and Amy Tsui. We are grateful to the Surgeons OverSeas organization, and in particular Dr. Reinou Groen, Dr. Shailvi Gupta, and Dr. Adam Kushner, for guidance from initial design to analysis of SOSAS and this specific report. We thank Ashley Morgan for editing this manuscript. We dedicate this report in memory of Mr. Charles Bambaiha, Mr. Allan Ssekindi, and Ms. Irene Tusiime.

Author contributions

SHF, TMT, ATF, and EKB conducted the literature search. TMT, LA, and JRV made the tables and figures. ATF, EKB, CS, FM, SL, CM, DBN, JGC, MG, and MMH designed the study. ATF, TMT, and CM supervised data collection. SHF, JRV, TMT, ATF, EKB, LA, CS, FM, SL, JGC, MG, and MMH analyzed and interpreted the data. DBN helped interpret the data. SHF, JRV, and TMT wrote the report. All authors commented on and critically revised the manuscript.

Funding

Funding was provided by the Duke Global Health Institute, Duke University Department of Neurosurgery, University of Minnesota Department of Surgery, Makerere University College of Health Sciences, and Johnson and Johnson Family of Companies. Dr. Staton would like to acknowledge salary support funding from the Fogarty International Center (Staton, K01 TW010000-01A1). Funding sources played no role in study design, data collection, data analysis, or writing of the manuscript. All authors had full access to the data and had final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    S. Harrison Farber & Anthony T. Fuller

  2. Division of Duke Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke University Medical Center, 4508 Hospital South, Durham, NC, 27710, USA

    S. Harrison Farber, Joao Ricardo Nickenig Vissoci, Tu M. Tran, Anthony T. Fuller, Luciano Andrade, Catherine Staton & Michael M. Haglund

  3. Duke University Global Health Institute, Durham, NC, USA

    Joao Ricardo Nickenig Vissoci, Tu M. Tran, Anthony T. Fuller, Catherine Staton & Michael M. Haglund

  4. Department of Medicine, Faculdade Inga, Maringa, PR, Brazil

    Joao Ricardo Nickenig Vissoci

  5. University of Minnesota Medical School, Minneapolis, MN, USA

    Elissa K. Butler

  6. Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Catherine Staton

  7. Makerere University School of Public Health, Kampala, Uganda

    Fredrick Makumbi & Christine Muhumuza

  8. Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda

    Samuel Luboga

  9. Ministry of Health, Government of Uganda, Kampala, Uganda

    Didacus B. Namanya

  10. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Jeffrey G. Chipman

  11. Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda

    Moses Galukande

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  1. S. Harrison Farber
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Correspondence to Michael M. Haglund.

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Farber, S.H., Vissoci, J.R.N., Tran, T.M. et al. Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data. World J Surg 41, 353–363 (2017). https://doi.org/10.1007/s00268-016-3689-5

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