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Survey of surgical emergencies in a rural population in the Northern Areas of Pakistan
Author(s) -
Ahmed Mushtaq,
Shah Mehboob,
Luby Stephen,
DragoJohnson Philomena,
Wali Sifat
Publication year - 1999
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1046/j.1365-3156.1999.00490.x
Subject(s) - medicine , incidence (geometry) , population , abdomen , rural area , acute abdomen , poison control , mortality rate , injury prevention , occupational safety and health , demography , pediatrics , surgery , environmental health , physics , pathology , sociology , optics
Summary objective To determine the incidence of specific surgical emergencies in a mountainous rural community in the Northern Areas of Pakistan and to assess use of existing health services, and outcomes related to acute surgical illness events. method A cross‐sectional population‐based survey was conducted. Interviewers visited each of 118 villages in the study area (population 1), selected a random sample from a total of 9900 households, and interviewed the oldest premenopausal female member ( n = 836). Questions were focused on injury, acute abdomen, and/or maternal morbidity occurring in the past year. Cases were included as surgical emergencies when one or more index clinical features indicating a potential for surgical intervention were present. Mortality from a wider range of surgical emergencies was also elicited based on the respondent's lifetime knowledge of the household. results The incidence rates were 1531/1 persons per year for injuries; 1364/1 for acute abdomen, and 16462/1 for maternal morbidity. The rate of injuries was 2.7 times higher and that of acute abdomen twice as high in males as in females. The injury rate decreased with advancing age, being 13 times higher in children < 5 years than in adults > 40. By contrast, the rate for acute abdomen showed a rise with advancing age, being 8 times higher in the > 40 age group than in under‐fives. Burns, falls and road accidents, in that order, were the commonest forms of injury accounting for 82% of 138 cases. Of 43 burn casualties, 46% were in the age group < 5 years; there was no gender bias. Of 71 casualties from falls and road accidents, 85% were aged 6–40 years; there was 6 : 1 male predominance. The maternal morbidity rate was highest in the age group 25–35 years and may be attributed to the high pregnancy rate in this age bracket. Of 408 patients with acute surgical illness, 85% were managed initially at home or close to home in a health centre, dispensary or civil hospital; 32% eventually sought specialist surgical care. The overall rate for minor and major surgical procedures was 411/1 persons per year (lowest estimate), and appeared to be low. The rate of operative deliveries at 11.8/1000 deliveries (lowest estimate) was particularly low. The mortality rates were correspondingly high: 55/1 persons per year for injuries and for acute abdomen (lowest estimates). The maternal mortality ratio was particularly high at 8.9/1000 deliveries (lowest estimate). Annual mortality rates derived from deaths recalled during the respondent's lifetime in the household (mean period = 26 years), tended to corroborate the results of the 1‐year survey. conclusion The incidence rates for broad categories of serious acute surgical illness in the study population far exceeded the rates of acute surgical intervention. Mortality rates were correspondingly high. Such evidence points to a large unmet surgical need and ought to spur improvements in the health service.