Injury, disability and access to care in Rwanda: Results of a nationwide cross-sectional population study

Background Disparities in access to quality injury care are a growing concern worldwide, with over 90% of global injury-related morbidity and mortality occurring in lowincome countries. We describe the use of a survey tool that evaluates the prevalence of surgical conditions at the population level, with a focus on the burden of traumatic injuries, subsequent disabilities, and barriers to injury care in Rwanda. Methods The Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate surgical consultation or intervention. Questions are structured anatomically and designed around a representative spectrum of surgical conditions. Households in Rwanda were sampled using two-stage cluster sampling, and interviews were conducted over a one-month period in 52 villages nationwide, with representation of all 30 administrative districts. Injury-related results were descriptively analyzed and population-weighted by age and gender. Results A total of 1,627 households (3,175 individuals) were sampled; 1,185 lifetime injury-related surgical conditions were reported, with 38% resulting in some form of perceived disability. Of the population, 27.4%had ever had a serious injury-related condition, with 2.8% having an injury-related condition at the time of interview. Over 30% of household deaths in the previous year may have been surgically treatable, but only 4% were injury-related. Conclusions Determining accurate injury and disability burden is crucial to health system planning in low-income countries. SOSAS is a useful survey for determining injury epidemiology at the community level, which can in turn help to plan prevention efforts and optimize provision of care.