Prevalence of thoracic surgical care need in a developing country: Results of a cluster-randomized, cross-sectional nationwide survey

Background: Developing countries without established surgical capacity face heightened morbidity and mortality from poorly understood, untreated thoracic surgical impairments. This study sought to estimate the prevalence of thoracic surgical need in a low-income country and consider contributing factors involved. Methods: Cluster-randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool in Sierra Leone from January 9-February 3, 2012. Results: Data were collected and analyzed from 3645 respondents (response rate 98.3%). 273 (7.5%) reported ≥1 chest (including heart, lungs, and mediastinum) or breast surgical problem during their lifetime; 268 (7.4%) reported ≥1 back complaint. Multiple problems could be reported, resulting in a total of 277 chest/breast and 268 back complaints. The majority (184/545) were related to acquired deformities. Most occurred ≥12 months ago (364/545) and continued to impact the participant at the time of the interview (339/545). 322/545 sought care; however, 40% (130/322) did not receive care, predominately due to an inability to pay. Adjusted logistic regression found that chest/breast problems were more common among farm workers, older participants, and individuals with minimal education, while back problems were more common in the same groups and males. Conclusions: The study provides data on the prevalence of thoracic surgical conditions and factors affecting prevalence in one of the world's poorest countries. The results speak to the need for further work to enhance health systems strengthening while offering the opportunity for future training and research in resource-limited settings - an area of thoracic surgery that is not well understood.