Browsing by Author "Petroze, Robin T"

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Estimating Operative Disease Prevalence in a Low-income Country: Results of a Nationwide Population Survey in Rwanda
(MOSBY-ELSEVIER , 360 PARK AVENUE SOUTH, NEW YORK, USA, NY, 10010-1710, 2013) Petroze, Robin T; Groen, Reinou S; Niyonkuru, Francine; Mallory, Melissa; Ntaganda, Edmond; Joharifard, Shahrzad; Guterbock, Thomas M; Kushner, Adam L; Kyamanywa, Patrick; Calland, J Forrest
Background. Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda. Methods. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics. Results. A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8–43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3–16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6–7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services. Conclusion. The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda. (Surgery 2012)
Estimating Pediatric Surgical Need in Developing Countries: A Household Survey in Rwanda
(W B Saunders Co-Elsevier Inc , 1600 John F Kennedy Boulevard, Ste 1800, Philadelphia, Usa, Pa, 19103-2899, 2014) Petroze, Robin T; Calland, J Forrest; Niyonkuru, Francine; Groen, Reinou S; Kyamanywa, Patrick; Li, Yue; Guterbock, Thomas M; Rodgers, Bradley M; Rasmussen, Sara K
Purpose Surgical services for children are often absent in resource-limited settings. Identifying the prevalence of surgical disease at the community level is important for developing evidence-based pediatric surgical services and training. We hypothesize that the untreated surgical conditions in the pediatric population are largely uncharacterized and that such burden is significant and poorly understood. Furthermore, no such data exist at the population level to describe this population. Methods We conducted a nationwide cross-sectional cluster-based population survey to estimate the magnitude of surgical disease in Rwanda. Conducted as a verbal questionnaire, questions included representative congenital, acquired, malignant and injury-related conditions. Pediatric responses were analyzed using descriptive statistics and univariate analysis. Results A total of 1626 households (3175 individuals) were sampled with a 99% response rate; 51.1% of all individuals surveyed were younger than age 18. An estimated 50.5% of the total current surgical need occurs in children. Of all Rwandan children, 6.3% (95% CI 5.4%–7.4%), an estimated 341,164 individuals, were identified to have a potentially treatable surgical condition at the time of the interview. The geographic distribution of surgical conditions significantly differed between adults and children (p < 0.001). Conclusions The results emphasize the magnitude of the pediatric surgery need as well as the need for improved education and resources. This may be useful in developing a collaborative local training program.
Infectious Outcomes Assessment for Health System Strengthening in Low-resource Settings: The Novel Use of a Trauma Registry in Rwanda
(Mary Ann Liebert, Inc , 140 Huguenot Street, 3rd Fl, New Rochelle, Usa, Ny, 10801, 2014) Petroze, Robin T; Byiringiro, Jean Claude; Kyamanywa, Patrick; Ntakiyiruta, Georges; Calland, J Forrest; Sawyer, Robert G
Background: More than 90% of injury deaths occur in low-income countries where a shortage of personnel, infrastructure, and materials challenge health system strengthening efforts. Trauma registries developed regionally have been used previously for injury surveillance in resource-limited settings, but scant outcomes data exist. Methods: A 31-item, two-page registry form was developed for use in Rwanda, East Africa. Data were collected over a one-year period from April 2011 to April 2012 at two university referral hospitals. Inpatient 30-d follow up data were abstracted from patient charts, ward reports, and operating room logs. Complications tracked included surgical site infection (SSI), pneumonia, urinary tract infection (UTI), decubitus ulcers, transfusion, cardiac arrest, respiratory failure, and blood thromboses. Univariate analysis with chi-square and the Fisher exact test was performed to determine the association between complications and hospital stay and complications and mortality. Multivariable logistic regression was used to control for age, gender, hospital, mechanism of injury (penetrating versus blunt), and Glasgow Coma scale score (GCS). Results: A total of 2,227 patients were recorded prospectively. One thousand five hundred nineteen patients were admitted for inpatient care (69%) with a 4% (n = 67) 30-d mortality. One hundred thirteen patients developed a hospital-acquired infection (88 SSI, 15 UTI, 12 pneumonia). For admitted patients, 25% (n = 387) were still in-hospital at 30-d. Whereas the development of any complication was associated with an increased mortality (p < 0.0001, unadjusted OR 3.2, 95% CI 1.8–5.7), there was no association between the development of an infection and mortality (p = 0.6). Hospital-acquired infection was associated with an increased length of stay (p < 0.0001, adjusted odds ratio (OR) 7.3, 95% confidence interval (CI) 4.7–11.2). Surgical site infection and UTI were individually associated with an increased length of stay. Conclusions: The development of hospital-acquired infections is associated with an increased hospital stay in the trauma population in Rwanda. This has important implications in improving a health system already strained by limited infrastructure, personnel, and finances.
Prevalence of Breast Masses and Barriers to Care: Results From a Population‐based Survey in Rwanda and Sierra Leone
(Wiley , 111 River St, Hoboken, Usa, Nj, 07030-5774, 2014) Ntirenganya, Faustin; Petroze, Robin T; Kamara, Thaim B; Groen, Reinou S; Kushner, Adam L; Kyamanywa, Patrick; Calland, J Forrest; Kingham, T Peter
Background and Objectives:Breast cancer incidence may be increasing in low‐and middle‐income countries (LMIC). This study estimates theprevalence of breast masses in Rwanda (RW) and Sierra Leone (SL) and identifies barriers to care for women with breast masses. only.Methods:Data were collected from households in RW and SL using Surgeons Overseas Assessment of Surgical Need (SOSAS), a cross‐sectional,randomized, cluster‐based population survey designed to identify surgical conditions. Data regarding breast masses and barriers to care in womenwith breast masses were analyzed.Results:3,469 households (1,626 RW; 1,843 SL) were surveyed and 6,820 persons (3,175 RW; 3,645 SL) interviewed. Breast mass prevalence was3.3% (SL) and 4.6% (RW). Overall, 93.8% of masses were in women, with 49.1% (SL) and 86.1% (RW) in women>30 years. 73.7% (SL) and92.4% (RW) of women reported no disability; this was their primary reason for not seeking medical attention. Overall, 36.8% of women who reportedmasses consulted traditional healers only.Conclusions:For women in RW and SL, minimal education, poverty, and reliance on traditional healers are barriers to medical care for breastmasses. Public health programs to increase awareness and decrease barriers are necessary to lower breast cancer mortality rates in low‐and middle‐income countries (LMIC).
Road Traffic Injuries: Cross-sectional Cluster Randomized Countrywide Population Data From 4 Low-income Countries
(Elsevier Science Inc , Ste 800, 230 Park Ave, New York, USA, NY, 10169, 2018) Zafar, Syed Nabeel; Canner, Joseph K; Nagarajan, Neeraja; Kushner, Adam L; Gupta, Shailvi; Tran, Tu M; Stewart, Barclay T; Kamara, Thaim B; Kyamanywa, Patrick; Amatya, Kapendra S; Galukande, Moses; Petroze, Robin T; Nwomeh, Benedict C; Smith, Emily R; Haglund, Michael M; Benedict Nwomeh, Benedict; Groen, Reinou S
Introduction Road traffic injuries (RTI) are a leading cause of morbidity and mortality around the world. The burden is highest in low and middle-income countries (LMICs) and is increasing. We aimed to describe the epidemiology of RTIs in 4 low-income countries using nationally representative survey data. Methods The Surgeons Overseas Assessment of Surgical Needs (SOSAS) survey tool was administered in four countries: Sierra Leone, Rwanda, Nepal and Uganda. We performed nationally representative cross-sectional, cluster randomized surveys in each country. Information regarding demographics, injury characteristics, anatomic location of injury, healthcare seeking behavior, and disability from injury was collected. Data were reported with descriptive statistics and evaluated for differences between the four countries using statistical tests where appropriate. Results A total of 13,765 respondents from 7115 households in the four countries were surveyed. RTIs occurred in 2.2% (2.0–2.5%) of the population and accounted for 12.9% (11.5–14.2%) of all injuries incurred. The mean age was 34 years (standard deviation ±1years); 74% were male. Motorcycle crashes accounted for 44.7% of all RTIs. The body regions most affected included head/face/neck (36.5%) followed by extremity fractures (32.2%). Healthcare was sought by 78% road injured; 14.8% underwent a major procedure (requiring anesthesia). Major disability resulting in limitations of work or daily activity occurred in 38.5% (33.0–43.9%). Conclusion RTIs account for a significant proportion of disability from injury. Younger men are most affected, raising concerns for potential detrimental consequences to local economies. Prevention initiatives are urgently needed to stem this growing burden of disease; additionally, improved access to timely emergency, trauma and surgical care may help alleviate the burden due to RTI in LMICs.
Self-reported Determinants of Access to Surgical Care in 3 Developing Countries
(Amer Medical Assoc , 330 N Wabash Ave, Ste 39300, Chicago, Usa, Il, 60611-5885, 2016) Forrester, Joseph D; Forrester, Jared A; Kamara, Thaim B; Groen, Reinou S; Shrestha, Sunil; Gupta, Shailvi; Kyamanywa, Patrick; Petroze, Robin T; Kushner, Adam L; Wren, Sherry M
IMPORTANCE Surgical care is recognized as a growing component of global public health. OBJECTIVE To assess self-reported barriers to access of surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool. DESIGN, SETTING, AND PARTICIPANTS Data for this cross-sectional, cluster-based population survey were collected from households in Rwanda (October 2011), Sierra Leone (January 2012), and Nepal (May and June 2014) using the Surgeons OverSeas Assessment of Surgical Need tool. MAIN OUTCOMES AND MEASURES Basic demographic information, cost and mode of transportation to health care facilities, and barriers to access to surgical care of persons dying within the past year were analyzed. RESULTS A total of 4822 households were surveyed in Nepal, Rwanda, and Sierra Leone. Primary health care facilities were commonly reached rapidly by foot (>70%), transportation to secondary facilities differed by country, and public transportation was ubiquitously required for access to a tertiary care facility (46%-82% of respondents). Reasons for not seeking surgical care when needed included no money for health care (Sierra Leone: n = 103; 55%), a person dying before health care could be arranged (all countries: 32%-43%), no health care facility available (Nepal: n = 11; 42%), and a lack of trust in health care (Rwanda: n = 6; 26%). CONCLUSIONS AND RELEVANCE Self-reported determinants of access to surgical care vary widely among Sierra Leone, Rwanda, and Nepal, although commonalities exist. Understanding the epidemiology of barriers to surgical care is essential to effectively provide surgical service as a public health commodity in developing countries.