The spatial distribution of injuries in need of surgical intervention in Nepal

  • Shailvi Gupta | shailvi.gupta@gmail.com University of California, San Francisco East Bay and Surgeons OverSeas, Oakland, CA, United States.
  • Thomas A. Groen University of Twente, Enschede, Netherlands.
  • Barclay T. Stewart University of Washington, Seattle, WA, USA; Department of Interdisciplinary Sciences, Stellenbosch University, Cape Town, South Africa.
  • Sunil Shrestha Nepal Medical College, Kathmandu, Nepal.
  • David A. Spiegel Children’s Hospital of Pennsylvania, Philadelphia, PA, United States.
  • Benedict C. Nwomeh Nationwide Children’s Hospital and Surgeons OverSeas, Columbus, United States.
  • Reinou S. Groen Johns Hopkins University School of Medicine and Surgeons OverSeas, Baltimore, MD, United States.
  • Adam L. Kushner Johns Hopkins Bloomberg School of Public Health and Surgeons OverSeas, Baltimore, MD, United States.

Abstract

Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R2=0.27). Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.

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Author Biographies

Shailvi Gupta, University of California, San Francisco East Bay and Surgeons OverSeas, Oakland, CA
Department of Surgery; Surgery Resident Physician
Barclay T. Stewart, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Sciences, Stellenbosch University, Cape Town
Department of Surgery; Surgery Resident Physician
Sunil Shrestha, Nepal Medical College, Kathmandu
Department of Surgery; Assistant Professor
David A. Spiegel, Children’s Hospital of Pennsylvania, Philadelphia, PA
Department of Orthopedic Surgery; Assistant Professor
Benedict C. Nwomeh, Nationwide Children’s Hospital and Surgeons OverSeas, Columbus
Department of Pediatric Surgery; Clinical Professor
Reinou S. Groen, Johns Hopkins University School of Medicine and Surgeons OverSeas, Baltimore, MD
Department of Obstetrics and Gynecology; Resident physician
Adam L. Kushner, Johns Hopkins Bloomberg School of Public Health and Surgeons OverSeas, Baltimore, MD
Department of International Health; Associate Professor
Published
2016-05-31
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Issue
Section
Original Articles
Keywords:
Global surgery, Geographic information system, Public health, Topography, Nepal
Statistics
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How to Cite
Gupta, S., Groen, T. A., Stewart, B. T., Shrestha, S., Spiegel, D. A., Nwomeh, B. C., Groen, R. S., & Kushner, A. L. (2016). The spatial distribution of injuries in need of surgical intervention in Nepal. Geospatial Health, 11(2). https://doi.org/10.4081/gh.2016.359