Abstract: Global Burden of Craniomaxillofacial Diseases - a Four Country Cluster Randomized Study Using the Sosas Instrument

Abstract

INTRODUCTION: It is estimated that 11% of the global disability-adjusted life years (DALYs) are attributable to surgically treatable diseases, 66% of which are related to injuries, masses, and congenital deformities.1 When located within the head, face, and neck region, plastic surgeons are particularly trained to treat these conditions, however most low-income countries report less than 5 plastic surgeons for their entire country.2 The purpose of this study was to describe the disease etiologies of the head, face, mouth, and neck region. Furthermore, it aims to explore the proportion of people receiving care, barriers to receiving care, and the long-term disability attributed to craniomaxillofacial diseases. METHODS: The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cluster randomized, cross sectional, country wide survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies demographic characteristics, etiology (e.g. burn / mass/ congenital deformity / trauma), timing of the disease, proportion seeking/receiving care, barriers to care, and disability. RESULTS: Across the four countries 13,763 individuals were surveyed with 1,413 diseases of head, face, mouth, and neck region identified. Rwanda reported the largest proportion of children (age < 6, 13.94%) and elders (age >64, 7.96%) with craniomaxillofacial diseases while Nepal had the greatest proportion of working aged individuals (age 15–64, 73.2%) (p<.001). Across the four countries diseases of the head were the most common craniomaxillofacial region reported with masses (22.13%) and trauma (32.8%) as the most common etiology. Nepal reported the largest proportion of masses (40.22%) and Rwanda reported the largest amount of trauma (52.65%) (p<.001). Rwanda had the highest proportion of individuals seeking (89.6%) and receiving care (83.63%) while Sierra Leone reported the fewest (60% vs 47.77%, p<.001). Rwanda also had the highest proportion of individuals reporting disability from craniomaxillofacial disease while Nepal reported the highest proportion with no disability (43.68% vs 79.33%, p<.001). CONCLUSION: This study is the largest of its kind evaluating craniomaxillofacial diseases from a multi-country population based perspective. Despite similar country socioeconomic make up there was significant variability across the four countries in demographic, craniomaxillofacial disease type, patterns of care seeking/receiving, and disability. These findings demonstrate the substantial burden of craniomaxillofacial diseases across four low-income countries and represents a call for increasing plastic surgery training in these countries. Reference Citations: 1. Debas, H.T., et al., Disease Control Priorities, (Volume 1): Essential Surgery. 2015: World Bank Publications. 2. Semer, N.B., S.R. Sullivan, and J.G. Meara, Plastic surgery and global health: how plastic surgery impacts the global burden of surgical disease. J Plast Reconstr Aesthet Surg, 2010. 63(8): p. 1244–8.