Directions for surgical capacity developments in Nepal

Directions for surgical capacity developments in Nepal: a population-based assessment

Knulst, A.J. (TU Delft Medical Instruments & Bio-Inspired Technology)
Gupta, Shailvi (R Adams Cowley Shock Trauma Center; Surgeons OverSeas)
Groen, Reinou S. (Alaska Native Medical Center; Johns Hopkins Hospital)
Maharjan, Dipak (INF Green Pastures Hospital & Rehabilitation Center)
Kapendra, Amatya S. (Nepal Cancer Hospital & Research Centre)
Dankelman, J. (TU Delft Medical Instruments & Bio-Inspired Technology)
Kushner, Adam L. (Surgeons OverSeas)

2019

Objectives: Lack of access to safe surgery is seen as a major issue that needs to be addressed. The aim of this study was to understand which combinations of factors relate to high occurrences of unmet needs and disability in Nepal, and consequently, how to focus future work to maximise impact in this country. Methods: A large population-based survey was conducted in Nepal in 2014 to evaluate the unmet surgical needs that result in disability. Recorded factors included diseased anatomical areas, disease specifics, disease locations, injury types, reasons for having an unmet need and the types of disability. Results: Included in the study were 2695 individuals. The anatomical areas facing the highest disabling unmet surgical need were Head (3.9% of population), Groin/Genitalia (2.2% of population) and Extremities (3.6% of population). Four focus areas could be defined. Increase affordability, availability and acceptability of surgical care to non-traumatic disabling conditions of (i) the eye, and (ii) extremities, and (iii) to traumatic disabling conditions of extremities and finally (iv) increase acceptability of having surgical care for non-traumatic conditions in the groin and genital area. For the latter, fear/no trust was the main reason for receiving no surgical care despite the resulting shame. Conclusions: This study defined four focus areas that showed the largest unmet needs that resulted in a perceived disability. For those areas, affordability, availability and acceptability of surgical need to be addressed through technical developments, capacity building and raising awareness.

disability
global surgery
low and middle income country
Nepal
unmet need

http://resolver.tudelft.nl/uuid:b0d052ba-976a-4bf1-822b-cd84f43f7d78

https://doi.org/10.1111/tmi.13292

1360-2276

Tropical Medicine and International Health, 24 (9), 1128-1137

Institutional Repository

journal article

© 2019 A.J. Knulst, Shailvi Gupta, Reinou S. Groen, Dipak Maharjan, Amatya S. Kapendra, J. Dankelman, Adam L. Kushner