# Face, head, and neck (FHN) problems and surgical need assessment among refugees living in Tanzania

## TL;DR

This study assesses the prevalence of face, head, and neck surgical needs among refugees in Tanzania, highlighting a significant unmet demand for otolaryngology services in refugee settings.

## Contribution

The study is the first to characterize the burden of OHNS disease in chronic refugee settings in low- and middle-income countries.

## Key findings

- Over half of the 462 refugees with FHN conditions reported a current surgical need.
- Non-injury-related wounds and non-congenitally acquired malformations were the most common pathologies.
- Age, nationality, religion, and pathology type were associated with increased surgical need.

## Abstract

Otolaryngology-head and neck surgery (OHNS) conditions comprise a considerable and underprioritized portion of the global burden of surgical disease. While OHNS conditions have been found to disproportionately impact low- and middle-income countries (LMICs), no studies to date have sought to characterize the burden of OHNS disease within chronic refugee settings in LMICs. The cluster-randomized, cross-sectional Surgeons Overseas Assessment of Surgical Need (SOSAS) survey tool was administered in Nyarugusu Refugee Camp in Makere, Tanzania in August and September of 2021 to estimate the prevalence of face, head, and neck (FHN) disease among refugees in East Africa and to identify predictors of surgical need. Demographic and clinical data were collected from all study participants. A multivariable logistical model was used to identify demographic and clinical characteristics associated with increased surgical need. 462 refugees reported having an FHN condition within their lifetime and 242 (52%) indicated a current surgical need for an FHN problem. Most conditions (n = 335; 73%) had persisted for over a year. The most common pathologies were non-injury-related wounds (n = 146; 35%) and non-congenitally acquired malformations (n = 118;28%). Multivariable analysis revealed several factors associated with increased surgical need including age, nationality, religion, and pathology type. There is a high burden of untreated surgical FHN conditions in Nyarugusu Refugee Camp. This study underscores the need for targeted interventions to expand otolaryngology-head and neck surgery (OHNS) services for FHN problems in under-resourced, protracted refugee settings. In addition to investing in OHNS surgical training programs, we advocate for temporizing interim non-surgical management while pursuing expedited referral for definitive surgical intervention.