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

World Journal of Surgery volume 39, pages 62–69 (2015)Cite this article

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.

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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.

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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

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  1. Robin T. Petroze
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Correspondence to J. Forrest Calland.

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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

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Keywords

  • Vital Statistic Data
  • Road Traffic Crash
  • Injury Epidemiology
  • Disability Burden
  • Health System Planning