Untreated Surgical Problems Among East African Refugees: A Cluster Randomized, Cross‐Sectional Study

Abstract

Objective The goal of this study was to estimate the prevalence of surgical conditions among refugees in East Africa. Background Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions in lowand middle-income countries. Despite numbering over 80 million people globally, forced migrant populations have often been neglected from this body of research. Methods We administered a validated survey using random cluster sampling to determine surgical need among refugees in western Tanzania. Primary outcome was history or presence of a surgical problem. Analysis included descriptive and multivariable logistic regression including an average marginal effects model. Results We analyzed data from 3,574 refugee participants in East Africa. A total of 1,654 participants (46.3%) reported a history or presence of at least one problem that may be surgical in nature. Of those 1,654 participants who did report a problem 1,022 participants (61.8%) reported the problem was still ongoing. Multivariable analysis revealed several factors associated with having a surgical problem (increasing age, occupation, illness within past year). Conclusion To our knowledge, this is the first and largest population-based survey in estimating the prevalence of surgical disease among refugees in sub-Saharan Africa. Our results imply that more than one-in-four refugees has an ongoing surgical problem, suggesting over double the burden of surgical need in refugee populations compared to non-refugee settings.

Reasons for referral and referral compliance among Congolese and Burundian refugees living in Tanzania: a community-based, cross-sectional survey

“…Finally, additional information on sampling is noted in the parent study. 22 The response rate of the parent study was 99% (3574/3610).…”

“…This project was part of a larger study on the surgical burden of disease among refugees in western Tanzania, where 3944 unique records were collected of which 153 reported they had been told they needed a referral and were available for analysis for this study. 22 The parent study used cluster randomised design. Nyarugusu refugee camp is divided into 14 administrative zones which are further divided into villages, clusters and households.…”

“…Additional records that we included were from clusters not originally in the random sample were also included for the sake of completion. Finally, additional information on sampling is noted in the parent study 22. The response rate of the parent study was 99% (3574/3610).…”

What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey

“…A population-based study design was used to understand the burden of untreated problems in this large refugee camp. This sample was a subsample of those from the parent study, where a sample size was calculated using the equation n = Z 2 p(1 – p)/L 2 , with n representing the total sample size, 95% Z value as 1.96, p as the estimated prevalence of surgical disease, and L as the acceptable level of precision (half-length of the 95% CI) around the estimated prevalence [7]. This produced an estimated sample size of at least 3519 individuals.…”

Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling

“…Data for this investigation is drawn from the parent study assessing the burden of surgical disease among refugees in western Tanzania where 1,658 met our inclusion criteria. In the parent study that had a 99% response rate, a total of 3,574 refugees were interviewed from 126 clusters (out of the initial randomly selected 132 clusters) [ 13 ]. The original required sample size for the parent study was calculated to be 3519 individuals based on the following equation: n = Z 2 p(1-p)/L 2 , where n is the total sample size, 95% Z value is 1.96, p is the estimated prevalence of surgical disease, and L is the accepted range around the estimated prevalence.…”