Richard A. Gosselin

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services?

A cost-effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability-adjusted life year (DALY) averted by health facilities in the developing world. We conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83–92). For the 3-month study period, total costs were calculated to be

Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care.

369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of

Key Concepts for Estimating the Burden of Surgical Conditions and the Unmet Need for Surgical Care

32.78. This figure compares favorably to other non-surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted. Surgical treatment of some common pathologies in developing countries may be more cost-effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context-specific, and more research is needed from developing countries to further refine the methodology and analysis.

Cost-Effectiveness of a District Trauma Hospital in Battambang, Cambodia

HYPOTHESIS Lack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nations ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone. SETTING Site visits were performed in 2008 at 10 of the 17 government civilian hospitals in Sierra Leone. MAIN OUTCOME MEASURES The World Health Organizations Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to assess surgical capacity. RESULTS There was a paucity of electricity, running water, oxygen, and fuel at the government hospitals in Sierra Leone. There were only 10 Sierra Leonean surgeons practicing in the surveyed government hospitals. Many procedures performed at most of the hospitals were cesarean sections, hernia repairs, and appendectomies. There were few supplies at any of the hospitals, forcing patients to provide their own. There was a disparity between conditions at the government hospitals and those at the private and mission hospitals. CONCLUSION There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nations surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.

Comparative Cost-Effectiveness Analysis of Two MSF Surgical Trauma Centers

BackgroundSurgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective.Method sA consensus opinion of a group of surgeons, anesthesiologists, and public health experts was established regarding the methodology for estimating the burden of surgical conditions and the unmet need for surgical care.Result sFor purposes of analysis, we define surgical conditions as any disease state requiring the expertise of a surgically trained provider. Abnormalities resulting from a surgical condition or its treatment are termed surgical sequelae. Surgical care is defined as any measure that reduces the rates of physical disability or premature death associated with a surgical condition. To measure the burden of surgical conditions and unmet need for surgical care we propose using cumulative disability-adjusted life-year (DALY) curves generated from age-specific population-based data. This conceptual framework is based on the premise that surgically associated disability and death is determined by the incidence of surgical conditions and the quantity and quality of surgical care. The burden of surgical conditions is defined as the total disability and premature deaths that would occur in a population should there be no surgical care; the unmet need for surgical care is defined as the potentially treatable disability and premature deaths due to surgical conditions. Burden of surgical conditions should be expressed as DALYs and unmet need as potential DALYs avertable.ConclusionsMethodology is described for estimating the burden of surgical conditions and unmet need for surgical care. Using this approach it will be feasible to estimate the global burden of surgical conditions and help clarify where surgery fits among other global health priorities. These methods need to be validated using population-based data.

The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities

AbstractBackgroundThe Emergency Hospital in Battambang, Cambodia, is essentially a surgical center for victims of injuries. MethodsUsing methods previously described, operating costs were calculated, and effectiveness of treatment was estimated for 957 patients undergoing 895 surgical procedures over a 3 month period (October–December 2006).ResultsResults of the cost-effectiveness analysis are compared to the few existing ones in the literature.ConclusionAt

Surgical services in low-income and middle-income countries

77.4 per DALY averted, surgery for trauma in such a context is deemed very cost-effective and compares favorably to other non-surgical public health interventions.

Population Health Metrics for Surgery: Effective Coverage of Surgical Services in Low-Income and Middle-Income Countries

IntroductionThere is a dearth of data on cost-effectiveness of surgical care in resource-poor countries. Doctors Without Borders (Médecins Sans Frontières; MSF) is a nongovernmental organization (NGO) involved in the many facets of health care for underserved populations, including surgical care.MethodsA cost-effectiveness analysis (CEA) was attempted at two of their surgical trauma hospitals: Teme Hospital in Nigeria and La Trinité Hospital in Haiti.ConclusionAt

Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients.

172 and