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Whether a mass casualty, earthquake or weather event at home, or a disaster abroad, proper preparation is essential for providing high-quality care. This concise guide brings together the views and knowledge of experienced responders to offer a much-needed review of the essential elements of anesthesia and intensive care for disasters and austere environments. Combining academic theory and practical advice, the book covers topics such as emergency and trauma surgery; airway management; chemical, biological and radiological exposure; personal protective equipment; and the psychological impact of working in the operating room in disaster situations. As successful care depends on the incident response team working collaboratively, the text also covers emergency communications, infrastructure preservation, and topics relevant to other medical specialists such as pain management and obstetrics. Featuring numerous high-quality illustrations, Essentials of Disaster Anesthesia is a vital, relevant resource for anesthetists, emergency physicians, nurses, and ancillary personnel.

Surgery and safe anesthesia have been neglected in low- and middle-income countries (LMICs) for decades. This neglect has resulted in poor infrastructure, and a limited surgical and anesthesia workforce, as well as limited access to and poor outcomes for many patients in need of surgery and safe anesthesia. The important events of 2015 created new interest in the role of surgery and anesthesia for global health and resulted in a commitment to improving surgical and anesthesia infrastructure, growing a competent workforce, and increasing access to and outcomes for surgery and anesthesia.

INTRODUCTION: Studies estimate that 20% of adults suffer from chronic pain. A meta-analysis in low- and middle-income countries (LMICs) found 34% had chronic pain. There are few studies on pain prevalence gathered in Africa. This study surveyed the capital city of Mozambique. METHODS: This was a cross-sectional study employed in a community setting. The Vanderbilt Global Pain Survey comprised questions on the behaviour and attitudes of respondents regarding pain, including previously validated metrics: the Pain Catastrophizing Scale, the World Health Organization Disability Assessment Schedule, the Brief Pain Inventory, Widespread Pain Index and Symptom Severity Score, and the Michigan Body Map. RESULTS: Ninety-seven surveys were completed out of 100. Pain every day lasting for more than 6 months in their lifetime was reported as 39.2% (CI: 29.4–49.6), and 52% of respondents had pain the day of the interview. However, the pain resulted in little difficulty with activities of daily living and maintaining relationships (61%–89%). Although none reported mental health disorders, 53.6% had experienced a traumatic event in their life, with 45.2% having related nightmares, anxiety, or fear. Most respondents (99%) would take oral medication if it helped their pain, with a large proportion willing to spend significant money for these (49% would pay >US$40) and willing to travel long distances to get help (55.2% would travel >40 kilometer). CONCLUSION: The prevalence of chronic pain in Maputo, Mozambique is similar to the average for LMICs. Trends in high-income countries suggest that multimodal pain management and multidisciplinary treatments may improve optimal pain control in LMICs.

Background The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT. Methods Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT. At the first postoperative visit, a symptom severity and quality of life questionnaire was completed. Additional objective metrics were extracted from the anesthesia record. Results A total of 102 patients were enrolled; 49 assigned to the SGA group and 53 assigned to the ETT group. No significant differences in swallowing function or cough were identified. SGA patients reported more difficulty returning to a normal diet (p = 0.03) with a trend toward reduced throat pain (p = 0.07) and improved phonation (p = 0.06). No significant difference in perioperative oxygen desaturations, emesis, recovery time, or airway blood penetration were identified. Conclusion While the use of the SGA results in patient diet modification postoperatively, it may also be associated with a reduction in throat pain and dysphonia. SGA use had no appreciable effect on postanesthesia recovery times, oxygen desaturations, or emesis. Use of the SGA in sinonasal surgery appears to be a safe and reliable option for airway management in selected adult patients undergoing routine ambulatory sinonasal surgery.

Measuring the extent and impact of a health problem is key to being able to address it appropriately. This review uses available information within the framework of the Global Burden of Disease studies to estimate the disease burden due to burn injuries of the hands. The GBD indicates that since 1990 there has been an approximately 30% decrease in the disease burden related to burn injuries. The GBD methods have not been applied specifically to hand burns, but from available data, it is estimated that about 18 million people in the world suffer from sequelae of burns to the hands.

Background Monitoring improvements in nationwide anesthesia capacity over time is critical to ensuring that population anesthesia needs are being met and identifying areas for targeted health systems interventions. Anesthesia resources in Bangladesh were previously measured using a cross-sectional nationwide hospital-based survey in 2012. No follow-up studies have been conducted since then. Methods A follow-up cross-sectional study was performed in 16 public hospitals; 8 of which are public district hospitals, and 8 are medical college (tertiary) hospitals in Bangladesh. A survey tool assessing hospital anesthesia capacity, developed by Vanderbilt University Medical Center, was utilized. Nationwide data were obtained from the Ministry of Health and Family Welfare and from the Bangladesh Society of Anaesthesiologists. Institutional Review Board approvals were obtained in the United States and Bangladesh, and informed consent was waived. Results Bangladesh has 952 anesthesiologists (0.58 anesthesiologists per 100,000 people), which represents a modest increase from 850 anesthesiologists in 2012. Significant improvements in electricity and clean water availability have occurred since the 2012 survey. Severe deficiencies in patient safety and monitoring equipment (eg, pulse oximetry, electrocardiography, blood pressure, anesthesia machines, and intubation materials) were noted, primarily at the district hospital level. Conclusions Despite modest improvements in certain anesthesia metrics over the past several years, the public health care system in Bangladesh still suffers from substantial deficiencies in anesthesia care.

The global burden of chronic pain is projected to be large and growing, in concert with the burden of noncommunicable diseases. This is the first systematic review and meta-analysis of the prevalence of chronic pain without clear etiology in general, elderly, and working populations of low- and middle-income countries (LMICs).We collected and reported data using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, excluding acute pain or pain associated with a concurrent medical condition. One hundred nineteen publications in 28 LMICs were identified for systematic review; the 68 reports that focused on general adult populations (GP), elderly general populations (EGP), or workers (W) were evaluated using mixed-effects regression meta-analysis.Average chronic pain prevalence is reported as a percentage of the population, with 95% confidence interval for each pain type and population (GP, EGP, and W; NA is equal to not available): unspecified chronic pain (34[26-42], 62[41-81], and NA); low back pain (21[15-27], 28[16-42], and 52[26-77]); headache (42[27-58], 30[19-43], and 51[13-88]); chronic daily headache (5[3-7], 5[1-12], and 10[0-33]); chronic migraine (GP 12[6-19]); chronic tension type headache (GP 8[3-15]); musculoskeletal pain (25[19-33], 44[28-62], and 79[60-94]); joint pain (14[11-18], 34[16-54], and NA); chronic pelvic/prostatitis pain (GP 4[0-14]); temporomandibular disorder (35[4-78], 8[0-24], and NA); abdominal pain (EGP 17[6-32]); fibromyalgia (Combined GP, EGP, W 6[5-7]); and widespread pain (7[1-18], 19[8-32], and NA). Chronic low back pain and musculoskeletal pain were 2.50 (1.21-4.10) and 3.11 (2.13-4.37) times more prevalent among W, relative to a GP. Musculoskeletal, joint, and unspecified pain were 1.74 (1.03-2.69), 2.36 (1.09-4.02), and 1.83 (1.13-2.65) times more prevalent among the EGP, relative to a GP. There was significant heterogeneity among studies for all pain types (I90%).Chronic pain is prevalent in LMICs, and where there was sufficient evidence, generally more prevalent in EGP and W. This meta-analysis reveals the spectrum of chronic pain without clear etiology in LMICs. Steps should be taken to reduce heterogeneity in the assessment of global chronic pain. Possible actions may include standardization of chronic pain definition, widespread adoption of validated questionnaires across cultures, attention to inequitably burdened populations, and inclusion of queries regarding known associations of chronic pain with social and psychological factors that, in combination, increase the global burden of noncommunicable disease and disability.

The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs.A comprehensive review of the Mozambique anesthesia system was conducted through interviews with personnel in the Ministry of Health (MOH), a school of medicine, a public central referral hospital, a general first referral hospital, a private care hospital, and leaders in the physician anesthesia community. Personnel databases were acquired from the MOH and Maputo Central Hospital.Quantitative results reveal minimal anesthesia capacity (290 anesthesia providers for a population of25 million or 0.01:10,000). The majority of physician anesthesiologists practice in urban settings, and many work in the private sector. There is minimal capacity for growth given only 1 Mozambique anesthesia residency with inadequate resources. The most commonly perceived barriers to safe anesthesia in this critical shortage are lack of teachers, lack of medical student interest in and exposure to anesthesia, need for more schools, low allocation to anesthesia from the list of available specialist prospects by MOH, and low public payments to anesthesiologists. Qualitative results show assets of a good health system design, a supportive environment for learning in the residency, improvement in anesthetic care in past decades, and a desire for more educational opportunities and teachers.Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.

Despite global efforts to reduce the maternal mortality ratio (MMR) through the World Health Organization's (WHO) Millennium Development Goal 5 (MDG5), MMR remains unacceptably high in low-income countries (LICs). Maternal death and disability from hemorrhage, infection, and obstructed labor may be averted by timely cesarean section (CS). Most LICs have CS rates less than that recommended by the WHO. Without access to timely CS, it is unlikely that MMR in LICs will be further reduced. Our purpose was to measure the MMR gap between the current MMR in LICs and the MMR if LICs were to raise their CS rates to the WHO recommended levels (10-15 %).This model makes the assumption that increasing the CS rates to the recommended rates of 10-15 % will similarly decrease the MMR in these LICs. WHO health statistics were used to generate estimated MMRs for countries with CS rates between 10 and 15 % (N = 14). A weighted MMR average was determined for these countries. This MMR was subtracted from the MMR of each LIC to determine the MMR gap. The percent decrease in MMR due to increasing CS rate was calculated and averaged across the LICs.We found an average 62.75 %, 95 %CI [56.38, 69.11 %] reduction in MMR when LICs increase their CS rates to WHO recommended levels (10-15 %).Maternal mortality is unacceptably high in LICs. Increasing CS rates to WHO recommended rates will decrease the maternal mortality in these countries, significantly decreasing the mortality ratio toward the projected MDG5.

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT.Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT. At the first postoperative visit, a symptom severity and quality of life questionnaire was completed. Additional objective metrics were extracted from the anesthesia record.A total of 102 patients were enrolled; 49 assigned to the SGA group and 53 assigned to the ETT group. No significant differences in swallowing function or cough were identified. SGA patients reported more difficulty returning to a normal diet (p = 0.03) with a trend toward reduced throat pain (p = 0.07) and improved phonation (p = 0.06). No significant difference in perioperative oxygen desaturations, emesis, recovery time, or airway blood penetration were identified.While the use of the SGA results in patient diet modification postoperatively, it may also be associated with a reduction in throat pain and dysphonia. SGA use had no appreciable effect on postanesthesia recovery times, oxygen desaturations, or emesis. Use of the SGA in sinonasal surgery appears to be a safe and reliable option for airway management in selected adult patients undergoing routine ambulatory sinonasal surgery.

The global population is expanding and rapidly aging, with the percentage population over age 65 years expected to double by 2030. This is paralleled by a rise in incidence of cancer and of chronic non-communicable disease. The World Health Organization estimates that newly diagnosed cancers will increase from 14 million to 22 million annually by 2035, with the greatest proportional rise expected in the developing world. Low and middle-income countries (LMICs) will experience 70 % increase in contribution by cancer to disability and premature death. The delivery of cancer care is a global challenge. Surgery remains a mainstay for cancer therapy. Inability to have timely surgical access is estimated to contribute to between 13 and 17 % loss of national global domestic product through loss of workforce productivity in LMIC and high-income countries, respectively, with cancer and injury accounting for more than 95 % of such annual economic welfare loss. In addition to a thorough understanding of cancer therapies and their associated alterations in physiology, it is crucial that perioperative clinicians ensure a safe, complication-free perioperative period for the cancer surgery patient, providing enhanced functional recovery to facilitate continuation of the cancer care journey with adjuvant therapy. Further, our understanding of perioperative perturbations that predispose to tumor spread and recurrence (which may arise from minimal residual disease, circulating tumor cells, or micrometastatic disease) following surgery is rapidly evolving, with the potential opportunity to adapt anesthetic and perioperative strategies. These factors will positively influence long-term cancer outcomes.

Since 2007, observations reveal that low- and middle-income countries (LICs and LMICs) experience similar surgical access and safety issues, though the etiology of these challenges varies by country. The collective voice of surveys completed to date has pushed the agenda for the inclusion of safe surgery and anesthesia within global health discussions. Comparison of four countries across the world shows similar basic progress as well as ongoing surgical and anesthesia needs in resource-challenged countries. By studying these common needs, a comprehensive plan to provide infrastructure and personnel support can work in multiple austere settings. A standardized survey tool published, designed, and developed initially by the Harvard Humanitarian Initiative and modified at Vanderbilt University was completed in Guatemala, Guyana, Laos, and Mozambique. The survey assessed eight key areas of essential surgical care: access to and availability of surgical services, access to human resources, essential infrastructure (including access to water, electricity, sanitation, blood products, and essential medicines including supplemental oxygen), surgical outcomes, operating room information and procedures, equipment, International Organization, and Non-Government Organization provision of surgical care. These results were compared and contrasted to evaluate resource challenges and assets in each country. A total of 49 hospitals were surveyed in this comparison cohort. The results reveal common needs for emergency and essential surgery in each country, but some differences in human and capital resources exist. While minimal resources exist, all surgical sites provided running water, electricity, and oxygen—assets not seen in previous surveys as recent as 2011. The most basic needs to provide essential surgery are now present in LICs and LMICs. Many more resources are needed to ensure access to safe surgery and anesthesia. The next steps to provide essential surgery must include common solutions for access to surgery and anesthesia, and an evaluation of patient safety in these endeavors through the perioperative mortality rate.

Current guidelines for the provision of safe anaesthesia from the World Health Organization and the World Federation of Societies of Anaesthesiologists (WFSA) are unachievable in a majority of low and middle-income countries (LMICs) worldwide. Current guidelines for anaesthesia and patient safety provisions from the WHO and WFSA are compared with local ability to achieve these recommendations in LMICs. Influential international organizations have historically published anaesthesia guidelines, but for the most part, without impacting substantial documentable changes or outcomes in low-income environments. This analysis, and subsequent recommendations, reviews the effectiveness of existing strategies for international guidelines, and proposes practical, step-wise implementation of patient safety approaches for LMICs.

The surgical and anaesthesia needs of low-income countries are mostly unknown due to the lack of data on surgical infrastructure and human resources. The goal of this study is to assess the surgical and anaesthesia capacity in Guyana.A survey tool adapted from the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to survey nine regional and district hospitals within the Ministry of Health system in Guyana.In nine hospitals across Guyana, there were an average of 0.7 obstetricians/gynaecologists, 3.5 non-OB surgeons, and 1 anaesthesiologist per hospital. District and regional hospitals performed an annual total of 1520 and 10,340 surgical cases, respectively. All but 2 district hospitals reported the ability to perform surgery. An average hospital has two operating rooms; 6 out of 9 hospitals reported routine medication shortages, and 4 out of 9 hospitals reported routine water or electricity shortages. Amongst the three regional hospitals, 16.1% of pregnancies resulted in Caesarean section.Surgical capacity varies by hospital type, with district hospitals having the least surgical capacity and surgical volume. District level hospitals routinely do not perform surgery due to lack of basic infrastructure and human resources.

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

Measuring the extent and impact of a health problem is key to being able to address it appropriately. This review uses available information within the framework of the Global Burden of Disease studies to estimate the disease burden due to burn injuries of the hands. The GBD indicates that since 1990 there has been an approximately 30% decrease in the disease burden related to burn injuries. The GBD methods have not been applied specifically to hand burns, but from available data, it is estimated that about 18 million people in the world suffer from sequelae of burns to the hands.

Low- and middle-income countries carry a disproportionate share of the global burden of pediatric surgical disease and have limited local healthcare infrastructure and human resources to address this burden. Humanitarian efforts that have improved or provided access to necessary basic or emergency surgery for children in these settings have included humanitarian assistance and disaster relief, short-term surgical missions, and long-term projects such as building pediatric specialty hospitals and provider networks. Each of these efforts may also include educational initiatives designed to increase local capacity. This article will provide an overview of pediatric humanitarian surgical outreach including reference to available evidence-based analyses of these platforms and make recommendations for surgical outreach initiatives for children.

This chapter addresses pain relief in areas of deprivation and conflict. There is variability in the causes of pain worldwide, including HIV/AIDS, torture-related pain and suffering, and war-related injuries. There is also great variability in the availability of adequate pain treatment worldwide due to limitations of education, training, knowledge of pain and its treatment, beliefs and communication about pain, and the inadequacy of access to drugs and palliative care in many countries. Research reflects the importance of extending pain care worldwide and addressing ethical and political issues surrounding pain care.

The importance of safe anesthesia for the best possible surgical outcomes in every patient is not disputed in high resource settings. Low-income countries lag far behind in the provision of, and training for, safe anesthesia practice. Too little is known about numbers and types of providers in a majority of low-income countries. A review of the member societies of the World Federation of Societies of Anaesthesiologists was undertaken, and membership statistics of national societies were requested. Of the 126 members of the federation, only 14 represent low-income countries. Many non-federation-member countries are also low-income countries. The anesthesia infrastructure and personnel challenges in low-income countries contribute to poor patient outcomes and limited access to emergency and essential surgery. The presence of a functional anesthesia society provides a measure of the numbers of providers and a snapshot of local professional activities. The establishment and maintenance of an anesthesia society is an indicator of respect for the profession and commitment to standards of practice, quality initiatives, and continuing medical education within the country.

The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery.A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors.There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade.POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.

There is a significant burden of disease in low-income countries that can benefit from surgical intervention. The goal of this survey was to evaluate the current ability of the Liberian health care system to provide safe surgical care and to identify unmet needs in regard to trained personnel, equipment, infrastructure, and outcomes measurement.A comprehensive survey tool was developed to assess physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, equipment and medications, and the capacity of the surgical system to collect and evaluate surgical outcomes at district-level hospitals in Africa. This tool was implemented in a sampling of 11 county hospitals in Liberia (January 2011). Data were obtained from the Ministry of Health and by direct government-affiliated hospital site visits.The total catchment area of the 11 hospitals surveyed was 2,313,429--equivalent to roughly 67 % of the population of Liberia (3,476,608). There were 13 major operating rooms and 34 (1.5 per 100,000 population) physicians delivering surgical, obstetric, or anesthesia care including 2 (0.1 per 100,000 population) who had completed formal postgraduate training programs in these specialty areas. The total number of surgical cases for 2010 was 7,654, with approximately 43 % of them being elective procedures. Among the facilities that tracked outcomes in 2010, a total of 11 intraoperative deaths (145 per 100,000 operative cases) were recorded for 2009. The 30-day postoperative mortality at hospitals providing data was 44 (1,359 per 100,000 operative cases). Metrics were also used to evaluate surgical output, safety of anesthesia, and the burden of obstetric disease.A significant volume of surgical care is being delivered at county hospitals throughout Liberia. The density and quality of appropriately trained personnel and infrastructure remain critically low. There is strong evidence for continued development of emergency and essential surgical services, as well as improved surgical outcomes tracking, at county hospitals in Liberia. These results serve to inform the international community and donors of the ongoing global surgical and anesthesia crisis.

Globally, 8 of the top 12 disabling conditions are related either to chronic pain or to the psychological conditions strongly associated with persistent pain. In this narrative review, we explore the demographic and psychosocial associations with chronic pain exclusively from low- and middle-income countries (LMICs) and compare them with current global data. One hundred nineteen publications in 28 LMICs were identified for review; associations with depression, anxiety, posttraumatic stress, insomnia, disability, gender, age, rural/urban location, education level, income, and additional sites of pain were analyzed for each type of chronic pain without clear etiology. Of the 119 publications reviewed, pain was described in association with disability in 50 publications, female gender in 40 publications, older age in 34 publications, depression in 36 publications, anxiety in 19 publications, and multiple somatic complaints in 13 publications. Women, elderly patients, and workers, especially in low-income and low-education subgroups, were more likely to have pain in multiple sites, mood disorders, and disabilities. In high-income countries, multisite pain without etiology, female gender, and association with mood disturbance and disability may be suggestive of a central sensitization syndrome (CSS). Because each type of prevalent chronic pain without known etiology reviewed had similar associations in LMICs, strategies for assessment and treatment of chronic pain worldwide should consider the possibility of prevalent CSS. Recognition is especially critical in resource-poor areas, because treatment of CSS is vastly different than localized chronic pain.

To assess the consistent availability of basic surgical resources at selected facilities in seven countries.In 2010-2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (Only 41 (34.2%) of the 120 study hospitals met the criteria for the provision of consistent basic surgical services. The combined catchments of the study hospitals in each study country varied between 3.3 million people in Liberia and 151.3 million people in Bangladesh. However, the combined catchments of the study hospitals in each study country that met the criteria for the provision of consistent basic surgical services were substantially smaller and varied between 1.3 million in Liberia and 79.2 million in Bangladesh.Many study facilities were deficient in the basic infrastructure necessary for providing basic surgical care on a consistent basis.Évaluer la disponibilité constante des ressources chirurgicales de base dans certains établissements de sept pays.En 2010–2014, nous avons utilisé un outil d'analyse de situation pour recueillir des données dans des hôpitaux régionaux et de district au Bangladesh (Seuls 41 (34,2%) des 120 hôpitaux analysés remplissaient les critères définissant une offre constante de services chirurgicaux de base. La population totale desservie par les hôpitaux analysés dans chaque pays allait de 3,3 millions de personnes au Liberia à 151,3 millions de personnes au Bangladesh. Cependant, la population totale desservie par les hôpitaux analysés dans chaque pays et qui remplissaient les critères définissant une offre constante de services chirurgicaux de base était nettement inférieure, allant de 1,3 millions de personnes au Liberia à 79,2 millions de personnes au Bangladesh.De nombreux établissements analysés n'avaient pas les infrastructures élémentaires nécessaires pour offrir de façon constante des soins chirurgicaux de base.Evaluar la disponibilidad coherente de recursos quirúrgicos básicos en centros seleccionados de siete países.En 2010–2014, se utilizó una herramienta de análisis situacional para recopilar datos en hospitales de distrito y regionales de Bangladesh (Únicamente 41 (34,2%) de los 120 hospitales del estudio cumplieron con los requisitos de suministro constante de servicios quirúrgicos básicos. Los beneficiarios combinados de los hospitales del estudio en cada país de estudio oscilaron entre 3,3 millones de personas en Liberia y 151,3 millones de personas en Bangladesh. Sin embargo, los beneficiarios combinados de los hospitales del estudio en cada país de estudio que cumplieron los criterios de suministro constante de servicios quirúrgicos básicos fueron mucho menores y oscilaron entre 1,3 millones en Liberia y 79,2 millones en Bangladesh.Muchos de los centros del estudio carecían de la infraestructura básica necesaria para suministrar atención quirúrgica básica de forma coherente.الغرض تقييم التوافر المستمر للموارد الجراحية الأساسية في المرافق المحددة في سبع دول. الطريقة في الفترة الممتدة ما بين عاميّ 2010 وحتى 2014، استخدمنا أداة تحليل ظرفية لجمع البيانات في المستشفيات الواقعة في الأحياء والمناطق في بنغلاديش (عدد旨在评估七个国家选定机构持续提供基本外科资源的能力。.在 2010 年到 2014 年期间,我们使用情景分析工具收集了埃塞俄比亚 (在调查的 120 家医院中,仅 41 (34.2%) 家医院满足标准,能够提供持续的基本外科服务。每个调查国家对象医院的综合服务范围人口在 330 万(利比里亚)和 15,130 万(孟加拉国)之间变动。但是,符合提供持续基本外科服务的调查国家对象医院的综合服务范围人口显著更小,在 130 万(利比里亚)和 7,920 万(孟加拉国)之间变动。.许多研究医疗机构在持续提供基本外科护理必要的基本设施方面存在不足。.Оценить постоянную доступность основных хирургических ресурсов в отдельных медицинских учреждениях в семи странах.В 2010–2014 годах мы использовали инструмент ситуационного анализа для сбора данных в районных и областных больницах в Бангладеш (Только 41 (34,2%) из 120 больниц, участвовавших в исследовании, отвечала критериям предоставления постоянных базовых хирургических услуг. Совокупные популяции, обслуживаемые исследуемыми больницами в каждой исследуемой стране, варьировались между 3,3 млн человек в Либерии и 151,3 млн человек в Бангладеш. Тем не менее совокупные популяции, обслуживаемые исследуемыми больницами в каждой исследуемой стране, которые соответствовали критериям предоставления постоянных базовых хирургических услуг, были существенно меньше и варьировались между 1,3 млн человек в Либерии и 79,2 млн человек в Бангладеш.Многие из исследуемых медицинских учреждений испытывали недостаток в базовой инфраструктуре, необходимой для обеспечения базовой хирургической помощи на постоянной основе.