A community survey of reported deaths and perceived disability associated with potentially untreated surgical conditions in a rural–urban population in Lagos, Nigeria: a SOSAS survey

Untreated surgical conditions contribute substantially to morbidity and mortality in low-resource settings, yet population-level data on surgical disability and premature mortality in Nigeria remain sparse. This study assessed surgical conditions, disability and mortality in a mixed rural–urban community in Lagos State. A community-based cross-sectional household survey was conducted in Ikorodu Local Government Area, Lagos State, in 2016 using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool. Eight hundred and fifty-six households comprising 3,984 individuals (1,986 adult informants and 1,998 children) were surveyed. Disability was recorded only when the informant explicitly attributed functional impairment to a surgical condition. Mortality covered the preceding 12 months. Years of life lost (YLL) were calculated for 43 deaths with individual age data using the WHO Nigeria 2015 life table. Exploratory years lived with disability (YLD) used representative disability weights and a one-year duration for respondents with perceived disability. Forty-six deaths were reported (32 adults, 14 children); the cause was unascertained for 36 (78.3%). The crude all-cause death rate was 11.5 per 1,000 persons (95% CI 8.7–15.4). Total YLL was 1,681.3 years (mean 39.1 years per death). Among adults, extremity conditions were the most frequently reported (91 of 169 classified pathology entries, 53.8%). Perceived disability was reported by 20 adults (1.0%) and 4 children (0.2%). Exploratory YLD was 1.55 years and total disability-adjusted life years (DALYs) were 1,682.9 years (422.4 per 1,000 persons), of which more than 99% was YLL. No surgically attributable mortality was estimated. Mortality ascertainment was limited by the high proportion of deaths with unascertained causes. Extremity conditions were the most frequently reported surgical problems, while perceived disability was uncommon. The findings support improved access to timely surgical care, referral pathways and community mortality surveillance.