Surgical Disease in Rural Area; the Pattern of Surgical Disease Prevalent in a Rural Area of Pakistan

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. www.theprofesional.com 801 SURGICAL DISEASE IN RURAL AREA 2 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% www.theprofesional.com 802 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 Professional Med J 2017;24(6):801-807. Number 722 258 211 174 118 31 17 1531 Table-VI. Orthopaedic www.theprofesional.com 1805 387 345 303 19 4094 Percentage 47.15% 16.85% 13.78% 11.36% 7.70% 2.02% 1.11% 99.97% 803 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 www.theprofesional.com 804 SURGICAL DISEASE IN RURAL AREA 5 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. www.theprofesional.com 805 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. 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Be good to yourself too.” Unknown 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. www.theprofesional.com Author=s Signature 807