abstract: 'Introduction: Musculoskeletal disease (MSD) is a major cause of

  disability in the global burden of disease, yet data regarding the

  magnitude of this burden in low and middle-income countries (LMICs) are

  lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS)

  survey was designed to measure incidence and prevalence of surgically

  treatable conditions, including MSD, in patients in LMICs.

  Methods: A countrywide survey was done in Nepal using SOSAS in May-June

  2014. Clusters were chosen based on population weighted random sampling.

  Chi squared tests and multivariate logistic regression assessed

  associations between demographic variables and MSD.

  Results: Self-reported MSDs were seen in 14.8\% of survey respondents

  with an unmet need of 60\%. The majority of MSDs (73.9\%) occurred

  between 1 and 12 months prior to the survey. Female sex (OR = 0.6; p <

  0.000), access to motorized transport (for secondary facility, OR =

  0.714; p < 0.012), and access to a tertiary health facility (OR = 0.512;

  p < 0.008) were associated with lower odds of MSD.

  Discussion: Based on this study, there are approximately 2.35 million

  people living with MSDs in Nepal. As the study identified

  non-availability, lack of money, and fear and/or lack of trust as the

  major barriers to orthopedic care in Nepal, future work should consider

  interventions to address these barriers.

  Conclusion: There is a need to increase surgical capacity in LMICs; in

  particular, there is a need to bolster trauma and orthopedic care.

  Previous studies have suggested ways to allocate resources to build

  capacity. We recommend targeting the alleviation of these identified

  barriers in parallel with capacity building. (C) 2016 IJS Publishing

  Group Ltd. Published by Elsevier Ltd. All rights reserved.'
affiliation: 'Chawla, SS (Corresponding Author), Mayo Clin \& Mayo Grad Sch Med, Rochester,
  MN 55905 USA.

  Chawla, Sagar S., Mayo Clin \& Mayo Grad Sch Med, Rochester, MN 55905 USA.

  Khanal, Subrat; Ghimire, Pranita, BP Koirala Inst Hlth Sci, Dharan, Nepal.

  Nagarajan, Neeraja, Johns Hopkins Univ, Sch Med Baltimore, Dept Surg, Baltimore,
  MD 21287 USA.

  Gupta, Shailvi, Univ Calif San Francisco East Bay, 1411 East 31st St, Oakland, CA
  94602 USA.

  Gupta, Shailvi; Kushner, Adam L., Surg OverSeas, New York, NY USA.

  Varadaraj, Varshini, Johns Hopkins Univ, Sch Med, Dept Ophthalmol, Baltimore, MD
  21287 USA.

  Nwomeh, Benedict C., Nationwide Childrens Hosp, Pediat Surg, Columbus, OH 43205
  USA.

  Kushner, Adam L., Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore,
  MD USA.'
author: Chawla, Sagar S. and Khanal, Subrat and Ghimire, Pranita and Nagarajan, Neeraja
  and Gupta, Shailvi and Varadaraj, Varshini and Nwomeh, Benedict C. and Kushner,
  Adam L.
author-email: 'sagarschawla@gmail.com

  subratkhanal033@gmail.com

  pranitaghimire690@gmail.com

  nnagara2@jhu.edu

  shailvi.gupta@gmail.com

  vvarada2@jhu.edu'
author_list:
- family: Chawla
  given: Sagar S.
- family: Khanal
  given: Subrat
- family: Ghimire
  given: Pranita
- family: Nagarajan
  given: Neeraja
- family: Gupta
  given: Shailvi
- family: Varadaraj
  given: Varshini
- family: Nwomeh
  given: Benedict C.
- family: Kushner
  given: Adam L.
da: '2023-09-28'
doi: 10.1016/j.ijsu.2016.08.522
eissn: 1743-9159
files: []
issn: 1743-9191
journal: INTERNATIONAL JOURNAL OF SURGERY
keywords: 'Essential surgery; Orthopedic surgery; Musculoskeletal disease; Surgical

  capacity; Low- and middle-income countries; Nepal'
keywords-plus: 'TRAUMA SERVICES; NONORTHOPAEDISTS; ORTHOPEDISTS; DISORDERS; INJURIES;

  CARE'
language: English
month: OCT
number-of-cited-references: '26'
orcid-numbers: 'Chawla, Sagar/0000-0003-1431-0766

  Kushner, Adam/0000-0002-7797-4837'
pages: 122-126
papis_id: f51ddee5cfae2724b9a04340fec942e9
ref: Chawla2016musculoskeletaldisea
researcherid-numbers: 'Khanal, Subrat/AAU-3638-2021

  Chawla, Sagar/AAR-1553-2020

  '
times-cited: '12'
title: 'Musculoskeletal disease in Nepal: A countrywide cross-sectional survey on
  burden and surgical access'
type: Article
unique-id: WOS:000386894600021
usage-count-last-180-days: '0'
usage-count-since-2013: '7'
volume: '34'
web-of-science-categories: Surgery
year: '2016'