World Journal of Surgery

, Volume 39, Issue 12, pp 2900–2907 | Cite as

Surgeons OverSeas Assessment of Surgical Need (SOSAS) Uganda: Update for Household Survey

  • Anthony T. Fuller
  • Elissa K. Butler
  • Tu M. Tran
  • Fredrick Makumbi
  • Samuel Luboga
  • Christine Muhumza
  • Jeffrey G. Chipman
  • Reinou S. Groen
  • Shailvi Gupta
  • Adam L. Kushner
  • Moses Galukande
  • Michael M. HaglundEmail author
Original Scientific Report



The first step in improving surgical care delivery in low- and middle-income countries (LMICs) is quantifying surgical need. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated household survey that has been previously implemented in three LMICs with great success. We implemented the SOSAS survey in Uganda, a medium-sized country with comparatively more language and ethnic group diversity.


The investigators partnered with the Performance Monitoring and Accountability 2020 (PMA2020) Uganda to access a data collection platform sampling 2520 households in 105 randomly selected enumeration areas. Due to geographic size consideration and language diversity, SOSAS’s methodology was updated in three significant dimensions (1) technology, (2) staff management, and (3) questionnaire adaptations.


The SOSAS survey was successfully implemented with non-medically trained but field proven research assistants. We sampled 2315 of 2402 eligible households (response rate 96.4 %) and 4248 of 4374 eligible individual respondents (response rate 97.1 %). The female-to-male ratio was 51.1–48.9 %. Total survey cost was USD 73,145 and data collection occurred in 14 days.


SOSAS Uganda has demonstrated that non-medically trained, but university-educated, experienced researchers supervised by academic surgeons can successfully perform accurate data collection of SOSAS. SOSAS can be successfully implemented within larger and more diverse LMICs using existing national survey platforms, and SOSAS Uganda provides insights on how SOSAS can be executed specifically within other PMA2020 program countries.


Questionnaire Adaptation Mobile Phone Data Data Collection Team Ugandan Context System Institutional Review Board 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the Uganda Bureau of Statistics for methodological advice and for providing randomized enumeration areas and the Uganda Ministry of Health and Makerere College of Health Sciences for institutional support. We thank the enumerators and field supervisors for their dedication to data quality. Duke Global Health Institute Seed Grant, Duke Division of Neurosurgery, Duke-Mulago Hospital Neurosurgery Training Program, Johnson & Johnson Family of Companies, Doris Duke International Clinical Research Fellowship, and University of Minnesota Department of Surgery.

Compliance with Ethical Standard

Conflicts of interest

The authors have no conflicts of interest.

Supplementary material

268_2015_3191_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)


  1. 1.
    Mock C (2013) Confronting the global burden of surgical disease. World J Surg 37(7):1457–1459. doi: 10.1007/s00268-013-2102-x CrossRefPubMedGoogle Scholar
  2. 2.
    Bickler SW, Spiegel DA (2008) Global surgery—defining a research agenda. Lancet 372(9633):90–92CrossRefPubMedGoogle Scholar
  3. 3.
    Debas HT, Gosselin R, McCord C et al (2006) Surgery in disease control priorities in developing countries, 2nd edn. World Bank, Washington, DC, pp 1245–1260Google Scholar
  4. 4.
    Meara JG, Leather A, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet ePub. doi: 10.1016/S0140-6736(15)60160-X Google Scholar
  5. 5.
    Kapiriri L, Norheim OF, Heggenhougen K (2003) Using burden of disease information for health planning in developing countries: the experience from Uganda. Soc Sci Med 56(12):2433–2441CrossRefPubMedGoogle Scholar
  6. 6.
    Luboga S, Macfarlane SB, von Schreeb J et al (2009) Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PloS Med 6(12):e1000200PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86(8):646–647PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Groen RS, Samai M, Petroze RT et al (2013) 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 CrossRefGoogle Scholar
  9. 9.
    Kwon S, Groen RS, Kamara TB et al (2013) Nationally representative household survey of surgery and mortality in sierra leone. World J Surg 37(8):1829–1835. doi: 10.1007/s00268-013-2035-4 CrossRefPubMedGoogle Scholar
  10. 10.
    Groen RS, Samai M, Stewart KA et al (2012) Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 380(9847):1082–1087CrossRefPubMedGoogle Scholar
  11. 11.
    Petroze RT, Groen RS, Niyonkuru F et al (2013) Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery 153(4):457–464CrossRefPubMedGoogle Scholar
  12. 12.
    Gupta S, Shrestha S, Ranit A et al (2015) Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal. Br J Surg 102(6):700–707CrossRefPubMedGoogle Scholar
  13. 13.
    Galukande M, von Schreeb J, Wladis A et al (2010) Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PloS Med 7(3):e1000243PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36(5):1056–1065. doi: 10.1007/s00268-012-1482-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Luboga S, Galukande M, Mabweijano J et al (2010) Key aspects of health policy development to improve surgical services in Uganda. World J Surg 34(11):2511–2517. doi: 10.1007/s00268-010-0585-2 PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Central Intelligence Agency (2014) The World Factbook. Washington DC. Accessed 2014 October 13.
  17. 17.
    Uganda Bureau of Statistics (2012) Uganda demographic and health survey 2011. Uganda Bureau of Statics, Kampala, UgandaGoogle Scholar
  18. 18.
    Uganda Bureau of Statistics (2014) National population and housing census provisional results. Uganda Bureau of Statistics, Kampala, UgandaGoogle Scholar
  19. 19.
    Haglund MM, Kiryabwire J, Parker S et al (2011) Surgical capacity building in Uganda through twinning, technology, and training camps. World J Surg 35:1175–1182. doi: 10.1007/s00268-011-1080-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Kambugu A, Meya DB, Rhein J et al (2008) Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy. Clin Infect Dis 46(11):1694–1701. doi: 10.1086/587667 PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Butler E, Tran T, Fuller A et al (2015) Burden of surgical conditions in Uganda: pilot study of a population-based survey in Wakiso District. Surgery ePub, UgandaGoogle Scholar
  22. 22.
    Gupta S, Ranjit A, Shrestha R et al (2014) Surgical needs of nepal: pilot study of population based survey in Pokhara, Nepal. World J Surg 38(12):3041–3046. doi: 10.1007/s00268-014-2753-2 CrossRefPubMedGoogle Scholar
  23. 23.
    Metzger MH, Goldberg M, Chastang JF et al (2002) Factors associated with self-reporting of chronic health problems in the French GAZEL cohort. J Clin Epidemiol 55(1):48–59CrossRefPubMedGoogle Scholar
  24. 24.
    Patel HD, Kamara TB, Kushner AL et al (2014) Estimating the prevalence of urinary and fecal incontinence in a nationally representative survey in Sierra Leone. Int J Gynaecol Obstet 126(2):175–176PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Uganda Ministry of Health (2010) Health Sector Strategic Plan III: 2010/11-2014/15. Ugandan Government Printing Office, Kampala, UgandaGoogle Scholar
  26. 26.
    UNICEF (2013) Uganda statistics. New York, NY: UNICEF. Accessed 2014 October 13
  27. 27.
    United Nations, Department of Economic and Social Affairs (2012) World Population Prospects, the 2012 Revision. Accessed 2014 October 13.

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Anthony T. Fuller
    • 1
    • 2
  • Elissa K. Butler
    • 3
  • Tu M. Tran
    • 2
  • Fredrick Makumbi
    • 4
  • Samuel Luboga
    • 5
  • Christine Muhumza
    • 4
  • Jeffrey G. Chipman
    • 6
  • Reinou S. Groen
    • 7
  • Shailvi Gupta
    • 8
  • Adam L. Kushner
    • 8
  • Moses Galukande
    • 9
  • Michael M. Haglund
    • 2
    • 10
    Email author
  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Duke University Global Health InstituteDurhamUSA
  3. 3.University of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Makerere University School of Public HealthKampalaUganda
  5. 5.Department of AnatomyMakerere University School of MedicineKampalaUganda
  6. 6.Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  7. 7.Department of Gynecology and ObstetricsJohns Hopkins HospitalBaltimoreUSA
  8. 8.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  9. 9.Department of SurgeryMakerere University College of Health SciencesKampalaUganda
  10. 10.Department of NeurosurgeryDuke UniversityDurhamUSA

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