Elsevier

Surgery

Volume 159, Issue 4, April 2016, Pages 1217-1226
Surgery

Global Medicine
Validation of a community-based survey assessing nonobstetric surgical conditions in Burera District, Rwanda

https://doi.org/10.1016/j.surg.2015.10.012Get rights and content

Background

Validated, community-based surveillance methods to monitor epidemiologic progress in surgery have not yet been employed for surgical capacity building. The goal of this study was to create and assess the validity of a community-based questionnaire collecting data on untreated surgically correctable disease throughout Burera District, Rwanda, to accurately plan for surgical services at a district hospital.

Methods

A structured interview to assess for 10 index surgically treatable conditions was created and underwent local focus group and pilot testing. Using a 2-stage cluster sampling design, Rwandan data collectors conducted the structured interview in 30 villages throughout the Burera District. Rwandan physicians revisited the surveyed households to perform physical examinations on all household members, used as the gold standard to validate the structured interview.

Results

A total of 2,990 individuals were surveyed and 2,094 (70%) were available for physical examination. The calculated sensitivity and specificity of the survey tool were 44.5% (95% CI, 38.9–50.2%) and 97.7% (95% CI, 96.9–98.3%), respectively. The conditions with the highest sensitivity and specificity were hydrocephalus, clubfoot, and injuries/infections. Injuries/infections and hernias/hydroceles were the conditions most frequently found on examination that were not reported during the interview.

Conclusion

This study provides the first attempt to validate a community-based surgical surveillance tool. The finding of low sensitivity was likely related to limited access to care and poor health literacy. Accurate community-based surveys are critical to planning integrated health systems that include surgical care as a core component.

Section snippets

Methods

A structured interview questionnaire to assess for the presence or absence of 10 index surgical conditions was created (Table I). Households in the Burera District were sampled randomly with inclusion of all individuals within the household. Results from the questionnaire were compared with the “gold standard” of a physician physical examination of participants included in the survey.

Results

Of the 690 households eligible for the study, 668 consented to the survey, yielding 2,990 individuals whose data were collected with the structured interview tool (Figure). Of these, 2,094 individuals (70%) were available for physical examinations. The study results are limited to these individuals available for both the survey and the physical examination.

Of the 2,094 study participants (from the 668 households), 27% (n = 561) responded for themselves on the structured interview. For the

Discussion

Community-based studies are important for understanding the true need for surgical care in many countries. This is especially relevant in low-income countries where operative logs and health management information systems data on procedures performed provide insufficient estimates because of widespread lack of access to surgical care. This study sought to validate a community-based survey for collecting surgical data in a rural district in Rwanda. Results revealed a low sensitivity and a high

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  • Institution of origination: Harvard Medical School.

    Funding: Harvard Sheldon Traveling Fellowship. This was used to assist with data collection.

    This manuscript was part of the Lancet Commission on Global Surgery.

    B.L.H.-G. received support from the Department of Global Health and Social Medicine Research Core at Harvard Medical School.

    Conflict of Interest: All authors report no biomedical financial interests or potential conflicts of interest.

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