SURGICAL DISEASE IN RURAL AREA
The Professional Medical Journal
www.theprofesional.com
ORIGINAL PROF-3843
DOI: 10.17957/TPMJ/17.3843
SURGICAL DISEASE IN RURAL AREA;
THE PATTERN OF SURGICAL DISEASE PREVALENT IN A RURAL AREA OF PAKISTAN
1. MD
General Prectitioner,
East Tamworth NSW Australia.
2. FCPS
Senior Registrar Surgery,
Allied Hospital, Faisalabad.
3. MBBS
Medical Officer
Riaz Hospital, Faisalabad
4. FRCS
Lahore.
Correspondence Address:
Dr. Faizan Riaz
Medical Officer
Riaz Hospital, Faisalabad
Article received on:
24/01/2017
Accepted for publication:
22/05/2017
Received after proof reading:
05/06/2017
Farhan Rathore1, Usman Riaz2, Faizan Riaz3, Altaf Hussain Rathore4
ABSTRACT… Objectives: To find out the prevalence of surgical disease in rural areas of
Pakistan. Place and Duration: All the surgical cases registered in Foundation Hospital Rajana
District Toba Tek Singh in 2012-2013. Methods: The whole data is analyzed by SSPS and
compared with the other studies of Pakistan and world. Results and Conclusion: Male and
female are equal in number in Total 7788 cases excluding non-surgical cases between 1 day
to above 70 years age. Majority of the cases were between 21-50 years age group. Common
cause was Trauma, commonest disease was L.B.A and commonest operation was for Hernia
and Gallbladder stones.
Key words:
Registration, Surgical Patients in rural, Population of Pakistan.
Article Citation: Rathore F, Riaz U, Riaz F, Rathore AH. Surgical Disease in Rural Area; The
pattern of surgical disease prevalent in a rural area of pakistan. Professional
Med J 2017;24(6):801-807. DOI: 10.17957/TPMJ/17.3843
INTRODUCTION
Foundation Hospital Rajana is a classical welfare
hospital run by a NGO based at Glasgow (UK). It
is meant mostly for the poor or middle class rural
population, District Toba Tek Singh of Punjab. This
75 bedded hospital is attached with a crowded
outdoor, a well equipped laboratory and most
modern radiology, ultrasound department and
operation theatre.
It caters for gynaecology, obstetrical, medical,
surgical, paediatric and neonatology cases.
There are two gynaecologists, one paediatrician,
one physician, one surgeon, one anaesthetist,
one pathologist and one radiologist cum
sinologist, four male medical officers and three
women medical officers. A general surgeon takes
all sort of surgical cases including minor trauma,
gastroenterology, chest, breast hepatobiliary
cases, thyroid, neck surgery, urology and cold
orthopaedic. We do not have a department of
acute trauma. The rural population comes to this
hospital for all sort of ailment including surgical
problems. We try to deal with them all locally to
their satisfaction. We perform surgical operations
under general, spinal, or local anaesthesia
depending upon the type of surgery, fitness and
preference of the patient. We do not perform
Professional Med J 2017;24(6):801-807.
the spinal, hip, cardiac, chest, complicated,
maxillofacial and neuro surgery.
MATERIAL AND METHODS
All the cold cases presenting to the hospital are
sorted out by receptionist for their speciality and
sent to their respective outdoor. All the patients
referred to the surgical department are seen by
the author in the surgical OPD four days in a
week. A detailed and quick history examination
is undertaken and proper investigations like
radiogram, Ultra sound or laboratory tests are
asked for, which are carried out in the same
hospital by latest machines by qualified personals.
They are hospitalized if they need admission
or treated as outdoor cases and prescribed the
proper medicines. If their disease belongs to
other specialities like gynaecology, obstetrics,
paediatrics, or medicine they are referred to the
proper hospital specialist.
RESULTS
Sex and age (Table-I)
Out of 8745 cases reported in surgical outdoor.
4724 were male 404 were female. The highest
number of cases were between 21-50 years age
group in males as well as in females.
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SURGICAL DISEASE IN RURAL AREA
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Causes of Diseases (Table-II)
The commonly specific causes were Trauma,
Infection and Degenerative diseases. Malignant
diseases are also not very uncommon. (Table-III)
System Involved (Table-IV)
Majority of cases belong to general surgery,
followed by orthopaedic and trauma, Urological
problems come in the third position.
General Surgery (Table-V)
Abdominal pathologies were the commonest
followed by minor ailments, Head and neck,
perineal (anorectal), breast cases are almost
Age in years
0-10
11-20
21-30
31-40
41-50
51-60
61-70
Above 70
Total
Male
529 (64.98%)
524 (48.29%)
840 (47.32%)
774 (46.15%)
703 (48.01%)
633 (62.30%)
448 (75.9%)
273 (84.2%)
4725(54.03%)
Causes
Deformity
Trauma
Infections
Tuberculos
Degenerative
Benign Growth
Malignancy
Others
Other specialties
Total
Organ
Breast
Gastrointestinal trace
Lymph Glands
Hepato Biliary
Bones
Head and Neck
Uroc enital tract
Other
Total
Professional Med J 2017;24(6):801-807.
equal in number but much less.
Orthopaedic (Table-VI)
L.B.A was leading causes of disabilities followed
by O.A of knees. Most of the amputations are due
to diabetes mellitus (VII).
Bone and Joint Injuries (Table-VIII)
Fracture of Tibia and Femur were commonest
followed by other bony injuries.
Urology (Table-IX)
Being enlargement of prostate is the commonest
problem followed by the kidney stone.
Female
285 (35%)
561 (51.70%)
935 (52.67%)
903 (53.84%)
761 (51.98%)
383 (37.6%)
142 (24.06%)
51 (15.74%)
4021 (48.03%)
Table-I. Age and sex
Total
814
1085
1775
1677
1464
1016
590
324
9619
Percentage
9.31%
12.40%
20.29%
19.17%
16.74%
11.61%
6.74%
3.70%
99.96%
Number
408
1311
1099
169
855
644
235
3067
957
8745
Table-II. Aetiology of the diseases
Percentage
4.66%
14.99%
12.57%
1.93%
9.77%
7.36%
2.68%
35.07%
10.94%
99.97%
Numbers
96
17
30
21
17
24
27
3
235
Table-III. Cancers
Percentage
40.85%
7.23%
12.76%
8.93%
7.23%
10.21%
11.49%
1.28%
99.98%
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SURGICAL DISEASE IN RURAL AREA
System
General surgery
Orthopedic and Trauma
Urology
Chest
Neuro surgery
Non-surgical
Total
System
Number
4094
2315
1266
68
45
957
8745
Table-IV. System involved
Disease
Hernias
Call bladder
Appendix
DU
Liver
Perforations
Obstruction
Goiter
Lymph Glands
Sallvary gand
Others
Piles
Fistula
Fissure
Prolaps
Rectal polyps
Cancer
Benign tumor
Dysplasia
Infection
Deformity
Abdomen
Head and Neck
Perineal
Breast
Varicose vein
Minor disease
3
Abcess infection cyst
tumor ulcer sinus
Total
Percentage
46.81%
26.47%
14.47%
0.77%
0.51%
10.94%
99.97%
Number
570
537
451
87
42
56
62
183
118
38
48
140
100
60
26
19
96
75
55
55
24
19
Percentage of Surgery
31.57%
29.75%
24.98%
4.81%
2.32%
3.10%
3.43%
47.28%
30.49%
9.81%
12.40%
40.57%
28.98%
17.39%
7.53%
5.50%
31.68%
24.75%
18.15%
17.49%
7.92%
0.46%
Grand total
1235
30.17%
1235
4094
Table-V. General Surgery
Disease
LBA
OA knee
OA other
Deformity
Amputations
Infection
New growth
Total
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Number
722
258
211
174
118
31
17
1531
Table-VI. Orthopaedic
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1805
387
345
303
19
4094
Percentage
47.15%
16.85%
13.78%
11.36%
7.70%
2.02%
1.11%
99.97%
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SURGICAL DISEASE IN RURAL AREA
Cause
DM
Trauma
Vascular diseases
Total
Disease
Multiple
Tibia
Femor
Colles
Humerous
Radius
Ulna
Pelvis
Small Bones
Dislocation
Total
Organs
Kidney & Ureter
Bladder
Prostate
Penis and uretra
Scrotum and
testes
Disease
Stones
Deformity
Malignancy
Infection
Stones
Incontinence
Malignancy
BPH
Stricture
Deformity
Circumcision
Hydroce
Varicocle
UDT
Infection
Tumor
Total
4
Number
74
39
5
118
Table-VII. Amputations
Percent
62.71%
33.06%
4.23%
100%
Number
45
130
129
55
48
27
25
22
300
10
791
Table-VIII. Fractures and dislocation
Percentage
5.68%
16.43%
16.30%
6.95%
6.06%
3.41%
3.16%
2.78%
37.92%
1.26%
99.95%
Number
Percentage
358
28.27%
20
1.57%
4
0.31%
48
3.87%
71
5.60%
12
0.94%
12
0.94%
387
30.56%
46
3.63%
42
3.31%
139
10.97%
55
4.34%
19
1.50%
13
1.02%
35
2.76%
5
0.39%
1266
99.98%
Table-IX. Urology
DISCUSSION
Surgical problems are increasing every day in the
whole world and account for 11% of all diseases1
Pakistan has its share. 64% of population live in
rural areas of Pakistan2 but nobody knows the
exact prevalence and pattern of surgical diseases
in this area. Toba Tek Singh district is a typical
rural area where agricultural lands are fertile, there
is no scarcity of water, climate is not very harsh
and the people are not very poor. The period of
Professional Med J 2017;24(6):801-807.
Grand total
430
95
387
227
127
1266
this study is 20 months. This study include all
subspecialties of surgery, through our Trauma
cases do not really represent the local statistics,
as we do not have acute trauma department in
our hospital. We have excluded non-surgical
cases in this study.
Male and female ratio is almost same in all the
age groups except below 10 year and above 50
years where men dominate. In the first decade it
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SURGICAL DISEASE IN RURAL AREA
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is perhaps due to the Muslim custom to get the
males circumcision in the early age but the cause
of the older group could not be understood.
perhaps due to prostatic enlargement in men.
is stretched along River Ravi.21 Beside it is the
common surgery of the neck done by general
surgeon in the whole world22, its incidence is
5-12% in females 2-5% in males.23,24
In the known causes of the disease trauma is
leading which goes in according to the study of
Sohail ET Al3,4 followed by infections. Though
malignant disease are not very common in
this area but still we have our share. Leading
malignancy in female population is breast cancer
which goes in accordance to our national5,6
and world figure7 Breast cancer occurs 69.1
per 100,000 population in Pakistan which is
equivalent to European and North America
rate.8 Like worldwide prevalence the commonest
symptom is low back aches.9,10 The commonest
disease admitted for operation is abdominal
hernia, followed by cholelcysteictomies.
Inperineal surgery piles are the leading morbidity
in this area. According to Gencosmaniglu et al
(25) 5% of the population of world and 50% after
50 years of age suffer from Piles , only 1/3 % goes
to the doctors.26
Majority of our cases belong to general surgery
which include abdominal pathologies, head
and neck, perianal and rectal diseases, breast,
varicose veins and minor surgical cases. It is
followed by orthopaedics and trauma, urology,
chest and neurosurgery. Abdominal hernia was
the most common cases in general surgery,
which goes in accordance to other regions of
Pakistan.11,12 It is followed by cholelithiasis and
appendicitis. Gallbladder disease comes third in
Pakistan in other study.13 Its incidence used to be
10 to 15 % in west and 2 to 5% in Asia and African
countries according to old studies in 199914 but
it is 10% in west and 17% in Asia.15 According to
new study, 14-16% in Pakistan13, 11.5% in Saudi
Arabia.16
Appendicitis is number 3 in our study which goes
against majority of study where it is most common
operation performed in general surgery.17,18
Its incidence is 1.5-1.9 percent population of
Pakistan19 in contrast to western standards where
it occurs in 8.6% in males and 6.7% in female
and highest incidence is between 22-26 years of
age.20
In head and neck surgery thyroidectomy is
leading perhaps due to the fact that this area
Professional Med J 2017;24(6):801-807.
In orthopaedics, the commonest ailment is
osteoarthritis if spine followed by knees and
other joints.9,10 Amputation minor or major is not
an uncommon operation where leading cause
is diabetes mellitus in our series and in world
literature27,28 though in some studies trauma is
a leading cause.29 As far fracture of long bone
are concerned, being superficial bone tibia is
most commonly fractured followed by femur
and colles which goes accordance to world
literature.30,31,32,33,34
Prostate enlargement is a leading disease in
urology in our study followed by urolithiasis.
Common occurrence of prostate disease in
Pakistan and whole word is due to growing aged
population.35 Prostatic cancer is not very common
in this area as compared to other area of Pakistan36
and world37 Urolithiasis is not uncommon with
us but less common than hot and dry areas of
Pakistan where scarcity of drinking water is real
problem.3,38 It is also a third common problem in
urology in most of the countries of the world.39
In scrotum hydrocele is the commonest problem
with us followed by varicocele, which goes in
accordance to Chukwadi et al40 and Siddique Et
Al.41
CONCLUSION
Surgical disease account 11% of all medical
problems.1 Their prevalence vary in different
geographical areas, socially, ethnic and economic
groups.42 In our series, the most common age
group is between 30 to 50 years, the commonest
cause of disease is Trauma, commonest disease
is low backache and commonest operations are
for Hernias followed by Gall bladder stone.
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SURGICAL DISEASE IN RURAL AREA
ACKNOWLEDGEMENT
We are grateful to Mr. Yasir Salim and Mr. Athar
Adrees for their statistical and secretarial help in
preparing this manuscript.
Copyright© 22 May, 2017.
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“Don’t just be good to others.
Be good to yourself too.”
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AUTHORSHIP AND CONTRIBUTION DECLARATION
Sr. #
Author-s Full Name
Contribution to the paper
1
Dr. Farhan Rathore
Main Author
2
Dr. Usman Riaz
Co-Author
3
Dr. Faizan Riaz
Co-Author
4
Prof. Altaf Hussain Rathore
Co-Author
Professional Med J 2017;24(6):801-807.
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