SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Cherukupalli, Srivarshini E.; Bhatia, Manisha; Boeck, Marissa A.; Blair, Kevin J.; Nagarajan, Neeraja; Gupta, Shailvi; Tatebe, Leah C; Sharma, Sumeet K.; Bhalla, Ashish; Nwomeh, Benedict C.; Swaroop, Mamta

doi:10.5334/aogh.2340

Cited by 6 publications

(14 citation statements)

References 25 publications

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“…According to the World Bank 2019 data, within South Asia, India was reported to have a lower number of physicians per 1000 individuals compared to Pakistan (0.7 vs. 1.1) (28). However, in correlation to the SOSAS study conducted in 2019 by Cherukupalli et al (5), the unmet surgical need in rural India was reported to be 6.5%, which is much lower than a staggering 14.3% in Pakistan as identified in this study.…”

Section: Discussioncontrasting

confidence: 43%

“…Considering that greater than 50% of the population in the least developed regions worldwide is children, we can surmise that the surgical burden amongst children in LMICs is immense (3, 4). Currently, a large disproportion exists between the wealthiest and poorest third of the population globally, with the wealthy receiving a major share of 73.6% of surgical procedures and the poor receiving only 3.5% (5). Within poor countries, surgical services are concentrated almost wholly in cities and reserved largely for those who can pay for them (1).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of pediatric surgical needs, health seeking behaviors and health systems in the rural district of Tando Mohammad Khan Sindh, Pakistan

Das

Meerza

Groen

et al. 2022

Preprint

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Background Surgical conditions are responsible for up to 15% of total DALY lost globally. Worldwide estimates have found that approximately 4.8 billion people have no access to surgical care. Within South Asia, greater than 95% of the population does not have access to care for conditions that require surgical management. Considering that greater than 50% of the population in the least developed regions worldwide is children, the surgical burden amongst children in LMICs is immense. In this study we use the SOSAS and PediPIPES in TMK district to assess the surgical needs of children under-5, quality of health facilities, and care seeking behavior in the community. Material and Methods The research was approved by the AKU ERC the NBC. Data was collected through the SOSAS and PediPIPES survey tools between November 2019 and February 2020 from a total of 3,643 households in the TMK, Sindh, Pakistan. The SOSAS survey was conducted by research associates trained for data collection. Household mothers provided information about their children. Health facilities were assessed using PediPIPES survey form. Information was collected from all 39 health care facilities in the district, including RHCs, BHUs, DCDs, and DHQ. Data was collected by core team and entered onto an excel sheet. Results A total of 3,643 households participated and information of 6,371 children was collected. A total of 1,794 children were identified to have 3,072 lesions that required surgical attention. We categorized the lesions requiring surgical care according to six regions of the body. Head and neck accounted for the greatest number of lesions (n = 1,697) and the most significant unmet surgical need (16.6%). The chest region had 102 lesions and the least unmet surgical need of 5.9%. The back accounted for 87 lesions with an unmet surgical need of 6.9%. The abdomen had 493 lesions and an unmet surgical need of 13.4%. A total of 169 lesions were found on buttocks/groin/genitalia region with an unmet surgical need of 14.8%, while extremities presented with 296 lesions amounting to 11.8% unmet surgical need. A total of 39 health facilities, consisting of one DHQ, three RHCs, 14 BHUs and 21 DCDs, were surveyed. Trained staff were only present at the DHQ. Basic procedures such as suturing, wound debridement, I&D were performed more commonly than the more complex procedures. Most hospitals were found to have a good availability of equipment and supplies. PediPIPES scores and indices were calculated for the 39 health facilities in the area. The DHQ was found to have the highest score. Conclusions This study holds great significance for evaluation of pediatric surgical burden in Pakistan. It provides important insight into the burden of children’s operative disease in Pakistan’s rural district of TMK. The results show a significant need for provision of surgical care and has important implications for the global operative community as well as for strengthening the local health system in Pakistan. This data is useful preliminary evidence that emphasizes the need to further evaluate interventions for strengthening surgical systems in rural Pakistan.

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Section: Discussioncontrasting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Assessment of pediatric surgical needs, health seeking behaviors and health systems in the rural district of Tando Mohammad Khan Sindh, Pakistan

Das

Meerza

Groen

et al. 2022

Preprint

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“…Investigating the reasons underlying these differences would require assessment of data coverage and completeness for HMIS and further breakdown by surgical conditions to better match the inclusion of the surgical condition across studies. Our population-based met need calculations cannot be compared with small-scale household surveys investigating lifetime surgical uptake (50) or studies using self-report instruments such as SOSAS (18, 19).…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the LCoGS and DCP3, small-to-medium scale regional studies have looked at surgical need in rural and urban areas (17–19). The national-level surgical need benchmark using data from a universal healthcare coverage (UHC) cohort (n = 88,273, Contributory Health Service Scheme (CHSS) members) was estimated to be 3646 procedures per 100,000 people (17).…”

Section: Introductionmentioning

confidence: 99%

“…However, this cohort did not demographically and socioeconomically match the Indian population, excluded certain kinds of surgeries, and assumed no accessibility or acceptability issues. Two studies using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) self-reports in low-income households in Ahmedabad city (n= 10,330 from 2066 households) (18) and rural Haryana (n= 93 from 50 households) (19) estimated the surgical need at 3.46% and 30.1% with unmet proportions at 42.33% and 6.5%, respectively. While useful, these estimates lack comprehensiveness for national-level planning and limited use for rural India.…”

Section: Introductionmentioning

confidence: 99%

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Analyzing Surgical Volumes, Rates, and Need in Rural India

Zadey

Vissoci

2021

Preprint

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BackgroundGlobally, 5 billion people lack timely access to safe and affordable surgical care, with over a fifth of them living in India. Solving India’s surgical access issues can have high returns on investment. While healthcare access and unaffordability problems are well-known in India particularly among its rural people, research on surgical volumes and need is scant. This study attempts to fill the research gap through high-resolution nationwide estimates that have direct implications for India’s national surgical plan.MethodsSecondary data analysis with a diverse geospatial and statistical toolbox was used to create the national, state, and district-level estimates for surgical rates and c- section proportions and their corresponding met need w.r.t. to the globally prescribed thresholds – 5000 major surgeries (those requiring anesthesia) per 100,000 (Lancet Commission on Global Surgery) and 10-15% of all institutional deliveries (World Health Organization).ResultsNationally, only 6.81% of need for major surgical operations was met for rural India. 13.6% of the institutional deliveries were c-sections falling within the WHO- prescribed range of 10-15%. There were marked variations at state and district-levels and significant rural-urban differences for surgical rates and c-section proportions. We validate our estimates based on data from Health Management and Information System against existing sources that are commonly used in academic and policy research.ConclusionsOur methodological workflow has high translational value for global surgery research in low-and-middle-income countries. For India, these are the first such nationwide findings that can direct the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

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Surgical Unmet Need in a Low‐Income Area of a Metropolitan City in India: A Cross‐Sectional Study

et al. 2020

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Introduction We investigated the burden of surgical conditions, level of unmet needs and reasons for non‐utilization of surgical services in a slum of Ahmedabad, India. Methods A community‐based cross‐sectional study was carried out from August to December 2019. Inclusion criteria was age > 14 years; any type of injury/condition that requires surgery; subject has had surgery in last 1 year, and death information of family members. Data were stored and coded in Microsoft excel and exported to IBM SPSS statistics version 25 software for data analysis. Frequencies and proportions (categorical variable) are used to summarize utilization of surgical services and understanding surgical need. The Surgeons Overseas Assessment of Surgical was used to identify surgical met and unmet needs translated into local language. Open Data Kit software was used to install questionnaire in the “Tablet” to collect information and stress‐free workflow in field. Results Out of 10,330 population in 2066 households, 7914 were more than 14 years of age. 3.46% (n = 274) people needed surgery; 116 did not avail surgery and were categorized in “unmet need.” Fifty percent of individuals with surgical needs had abdominal‐ or extremities‐related problems followed by eyes surgery need (14%); back, chest and breast surgical need was 13.5%. Seventeen percent of participants with surgical needs had wounds related to injury or accident while 63% had wounds that were not related to injury. Almost all participants had gone to a physician to seek healthcare, however 42% did not avail surgical care needed for a variety of reasons. Forty‐six percent of participants needing surgical care underwent major surgical procedure, while 11% had minor procedures. Financial reasons (34.5%) and lack of trust (35.3%) were major reasons for not availing surgical care. Conclusions and Relevance Ahmedabad is a relatively high income metropolitan city, has universally free health care and multiple healthcare facilities. Despite this, we have shown that there is significant unmet need for surgical procedures in the low‐income population. A unique finding was that most patients sought a consultation but approximately 50% did not avail of the free surgical procedures under the universally free health care system in this city. We propose creation of community healthcare workers focused on surgical conditions.

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SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Cited by 6 publications

References 25 publications

Assessment of pediatric surgical needs, health seeking behaviors and health systems in the rural district of Tando Mohammad Khan Sindh, Pakistan

Assessment of pediatric surgical needs, health seeking behaviors and health systems in the rural district of Tando Mohammad Khan Sindh, Pakistan

Analyzing Surgical Volumes, Rates, and Need in Rural India

Surgical Unmet Need in a Low‐Income Area of a Metropolitan City in India: A Cross‐Sectional Study

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