Nobhojit Roy

• MS (Gen Surg), MPH, PhD
• Lead Surgery & Anaesthesia at World Health Organization WHO

Background A surgical task-sharing programme was initiated by the Sierra Leonean Ministry of Health in 2011 to enhance public surgical capacity and equalise access between urban and rural populations by redistributing surgical tasks within a limited healthcare workforce. Methods This longitudinal nationwide study, involving all healthcare faciliti...

Background Trauma surgery is characterized by high-acuity, low-frequency events. While trauma remains a leading cause of death and disability worldwide, surgical residents experience reduced trauma operative volumes during training. This paper highlights an important innovation for improvement of trauma surgery training: use of camera systems to re...

Background: Falls are some of the most common childhood injuries. However, for vulnerable children in low- and middle-income countries (LMICs) such as India, mortality from a fall is nearly three times that of high-income countries. Despite fall being a leading cause of paediatric injury, detailed data from LMICs remain sparse. This study aims to a...

Background India’s caesarean delivery (CD) rate of 21.5% suggests adequate national access to CD but may mask significant disparities. We examined variation in CD rates across states (geography), wealth, and health care sector (public versus private). We also aimed to determine relative inequality in CD rates across wealth quintiles. Methods The c...

Snapshot of trauma and anesthesia care capacity and preparedness in resource-limited setup in the face of war: the case of northern Ethiopia. Hussien Endris Assen, KalabTesfaye, Kassaye Demeke Altaye, Aklilu Yiheyis, Khalid Jemal, Demeke Yilkal, Ashenafi Amsalu, Lema Derseh, Yophtahe W/Gerima, Tadesse Belayneh, Mekuanint Tiruneh, Almaw Bitew, Sew...

Introduction Blood transfusion is crucial, but low-income and middle-income countries like India face a severe shortage of banked blood. This study focuses on the Empowered Action Group (EAG) states in India, where healthcare is limited, and health outcomes are poor. Our objective was to assess the blood banking infrastructure and access to blood p...

Incidence of trauma is on the rise all over the world. Timely management of trauma patients is necessary to reduce both mortality and morbidity. Trauma care is provided in a wide range of health care facilities ranging from district hospitals to trauma centres, the latter of which have the resources and capabilities necessary to provide specialised...

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme usin...

Background & objectives Traumatic injuries, especially in low- and middle- income countries (LMICs), present significant challenges in patient resuscitation and healthcare delivery. This study explores the role of trauma training programmes in improving patient outcomes and reducing preventable trauma-related deaths. Methods A dual approach was ad...

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhan...

The worldwide anaesthesia workforce shortage is a concern and ‘shared responsibility’ for all the national or state anaesthetic societies and Ministries of Health. The Lancet Commission on Global Surgery estimated the need for 143 million additional surgeries each year globally. These would be included in the World Health Organization's (WHO) 44 es...

Importance Trauma causes over four million deaths annually, the majority of these in low- and middle-income countries. Implementing trauma quality improvement programs may improve outcomes, and though extensively used, high-quality evidence of their effectiveness is scarce. Objective To assess if implementing a trauma quality improvement program u...

Background Intimate partner violence (IPV) against women has harmful effects on their psychological and physical health. However, help-seeking for IPV is significantly low among women in the Indian context. This study examines the different factors that influence help-seeking behaviour among women in India. It also studies associations of the type...

Background: Breast cancer is the most common cancer afflicting women with an estimated 2.1 million new cases diagnosed globally every year. Breast cancer and its treatment significantly impair the patient’s physical mental health and thereby affect their overall quality of life (QOL). Our aim was to identify differences in long-term QOL between bre...

Interest in global surgery has surged amongst academics and practitioners in high-income countries (HICs), but it is unclear how frontline surgical practitioners in low-resource environments perceive the new field or its benefit. Our objective was to assess perceptions of academic global surgery amongst surgeons in low- and middle-income countries...

In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy parti...

Background Women empowerment is commonly believed to be an important factor affecting a woman’s likelihood of facing violence from her intimate partner. Even as countries invest in policies that aim to strengthen women empowerment, studies show that increase in women empowerment does not necessarily decrease intimate partner violence (IPV) against...

Background Breast cancer is the commonest cancer among women in India, yet the uptake of early detection programs is poor. This leads to late presentation, advanced stage at the time of diagnosis, and high mortality. Poor accessibility and affordability are the most commonly cited barriers to screening: we analyse socio-cultural factors influencing...

Purpose Breast cancer is the most common cancer afflicting women with an estimated 2.1 million new cases diagnosed globally every year. Breast cancer and its treatment significantly impair the patient’s physical mental health and thereby affect their overall quality of life (QOL). Our aim was to identify differences in long-term QOL between breast...

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Purpose The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by the patient’s cultura...

50 Studies Every Global Health Provider Should Know presents a diverse series of studies that illustrate key issues in global health. The book has been divided into eight sections, encompassing health systems and delivery, social medicine and ethics, infectious disease, women’s health, child health, non-communicable disease, mental health, and surg...

Background: Women experiencing intimate partner violence (IPV) do not find help-seeking an easy process, especially since much of IPV is normalized. Recognizing the violence, making a decision to seek help and selecting a source of help constitute a three-staged process for help-seeking. Each of these stages is layered by one or multiple barriers a...

There has always been interest in understanding what constitutes the good life and the basis for creating it. Much has been written about health and wellbeing at multiple scales, from the physical and psychological through to the societal and environmental. Wellbeing has been studied from the perspectives of psychology, medicine, economics, social...

Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in...

Background Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60–70% of the Indian population, scarce data regarding SSI rates are available from such ho...

Background Foot ulcer is the most common cause of hospitalisation among people with diabetes (PWD). The objective of the study is to determine the incidence of diabetic foot ulcers (DFUs) in the urban community in India and its relationship with glycemic level and demographic parameters like age and sex among diabetic patients. Methodology A retro...

Introduction: The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs). Methodology: We searched PubMed, Web of Science, S...

Objectives To evaluate the profile of non-urgent patients triaged ‘green’, as part of a triage trial in the emergency department (ED) of a secondary care hospital in India. The secondary aim was to validate the triage trial with the South African Triage Score (SATS). Design Prospective cohort study. Setting A secondary care hospital in Mumbai, In...

Background In India, caesarean delivery (CD) accounts for 17% of the births, of which 41% occur in private facilities. However, areas to CD in rural areas are limited, particularly for the poor populations. Little information is available on state-wise district-level CD rates by geography and the population wealth quintiles, especially in Madhya Pr...

Background Low rates of caesarean delivery (CD) (<10%) hinder access to a lifesaving procedure for the most vulnerable populations in low-resource settings, but there is a paucity of data regarding which factors contribute most to CD rates. Objectives We aimed to determine caesarean delivery rates at Bihar’s first referral units (FRUs) stratified...

Background Screening for breast cancer results in early diagnosis of the disease and improves survival. However, increasing participation of women in screening programs is challenging since it is influenced by socioeconomic and cultural factors. This study explores the relationship of socioeconomic and women empowerment factors with breast cancer s...

Low-and-middle-income countries (LMICs) bear a high burden of intimate partner violence (IPV). However, there are no reviews assimilating the factors affecting risk of IPV in LMICs. This systematic review (2010–20) identifies risk and protective factors of IPV in LMICs. We followed the PRISMA guidelines to review 399 studies and included 32 studies...

This commentary focuses on “intangible software”, defined as the range of ideas, norms, values and issues of power or trust that affect the performance of health systems. While the need to work with intangible software within health systems is increasingly being recognized, the practical hows of doing so have been given less attention. In this comm...

Introduction Outcomes in patients with isolated traumatic brain injury (iTBI) have not been evaluated comprehensively in low-income and middle-income countries. We aimed to study the in-hospital iTBI mortality and its associated risk factors in a prospective multicenter Indian trauma registry. Methods Patients with iTBI (head and neck Abbreviated...

Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance s...

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Objective: The pattern of head and neck injuries has been well studied in high-income countries, but the data are limited in low- and middle-income countries, which are disproportionately affected by trauma. We examined a prospective multicenter database to describe patterns and outcomes of head and neck injuries in urban India. Study design: Re...

Trauma is a leading cause of morbidity and mortality globally, with a significant burden attributable to the low- and middle-income countries (LMICs), where more than 90% of injury-related deaths occur. Road injuries contribute largely to the economic burden from trauma and are prevalent among adolescents and young adults. Trauma systems vary widel...

Background There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (U...

Patient referral management is an integral part of clinical practice. However, in low-resource settings, referrals are often delayed. The World Health Organization categorizes three types of referral delays; delay in seeking care, in reaching care and in receiving care. Using two case studies of maternal referrals (from a low-resource state in Indi...

Background Glasgow Coma Scale (GCS) is one of the most commonly used trauma scores and is a good predictor of outcome in traumatic brain injury (TBI) patients. There are other more complex scores with additional physiological parameters. Whether they discriminate better than GCS in predicting mortality in TBI patients is debatable. The aim of this...

Introduction Fall is the second common cause of trauma worldwide after road traffic injuries. Data on fall from high income countries (HIC) mostly includes injuries in children and elderly. There are very few studies from low-income countries (LMIC) that describe fall related injuries other than fragility fractures in elderly. This study describes...

Background It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibili...

There is great need for intentional investment in capacity building for thoracic surgical conditions. This article provides a brief overview of thoracic surgical capacity building for low- and middle-income countries using the Lancet framework of infrastructure, workforce, financing, and information management. The authors highlight the needs, oppo...

Background The Lancet Commission on Global Surgery (LCoGS) published its seminal report in 2015, carving a niche for global surgery academia. Six years after the LCoGS, a scoping review was conducted to see how the term 'global surgery' is characterized by the literature and how it relates to LCoGS and its domains. Methods PubMed was searched for...

Background: Studies from high income countries suggest improved survival for females as compared to males following trauma. However, data regarding differences in trauma outcomes between females and males is severely lacking from low- and middle-income countries. The objective of this study was to determine the association between sex and clinical...

Objective To compare experts’ perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness. Design A mixed-methods approach using a mult...

Background: Breast cancer screening results in early recovery, good prognosis and improving the overall survival due to disease. However, proportion of women undergoing breast cancer screening are minimal and their participation get influenced due to low socio-economic and women empowerment status (SES and WES). This study explores the relationship...

Background The COVID-19 pandemic and subsequent lockdowns adversely affected global health care services to varying extent. Emergency Services were affected along-with elective surgeries, to accommodate the added burden of COVID19 affected patients. We aimed to reflect, quantify and analyse the trends of essential surgeries and bellwether procedure...

Introduction Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a clus...

Background: The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders' perceptions of v...

Background Most trauma societies recommend intubation of trauma patients with Glasgow coma scale (GCS) ≤ 8, without robust evidence supporting it. Methods We examined the association between intubation and inhopital 30 day mortality in trauma patients arriving with GCS ≤ 8. The data were obtained using the Towards Improved Trauma Care Outcomes (TI...

Background The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by patients’ cultural...

Introduction : ‘In-home injuries’ are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of ‘in-home’ injuries and compare their outcomes with ‘outside home injuries’. Materials and Methods : The Australia...

Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced dur...

Introduction: Over 90% of trauma-related deaths occur in Low-and-Middle-Income Countries (LMICs) and traumatic Brain Injury (TBI) is a leading cause of mortality in the setting of polytrauma. Clinical outcomes in patients with isolated TBI (iTBI) differ from those with significant extracranial injuries and have not been evaluated comprehensively in...

Background: Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60-70% of the Indian population, scarce data regarding SSI rates are available from such h...

Background In Bihar, one of the most populous and poorest states in India, caesarean sections have increased over the last decade. However, an aggregated caesarean section rate at the state level may conceal inequities at the district level. Objectives The primary aim of this study was to analyse the inequalities in the geographical and socioecono...

Background Cancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is neces...

There is a critical shortage of blood available for transfusion in many low- and middle-income countries. The consequences of this scarcity are dire, resulting in uncounted morbidity and mortality from trauma, obstetric hemorrhage, and pediatric anemias, among numerous other conditions. The process of collecting blood from a donor to administering...

Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibil...

Objectives Comparisons of risk-adjusted trauma mortality between high-income countries and low and middle-income countries (LMICs) can be used to identify specific patient populations and injury patterns for targeted interventions. Due to a paucity of granular patient and injury data from LMICs, there is a lack of such comparisons. This study aims...

Introduction Globally, nine million people are injured due to fire, heat and hot substances every year with a mortality rate of 1.34%. Research shows conflicting reports regarding sex as a risk factor for mortality in patient with burns. We analysed whether sex is a risk factor for in-hospital mortality in patients admitted with burns in urban Indi...

ABSTRACT Introduction The home environment is an important setting for injuries, accounting for 20% of all injury-related deaths in the US. Although most home injuries are considered minor in severity, they are associated with significant mortality because of the predominant involvement of vulnerable population groups (children and elderly). In dev...

Safe blood is a scarce resource, especially in low- and middle-income countries. Over 50% of blood is donated and utilized in high-income countries such as the United States, Canada, Europe and Australia. Although the number of hemorrhage-related deaths each year is unknown, at least 5 million people annually die from trauma-related injuries, overw...

Background Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lackin...

Introduction Trauma accounts for nearly one-tenth of the global disability-adjusted life-years, a large proportion of which is seen in low- and middle-income countries (LMICs). Trauma can affect employment opportunities, reduce social participation, be influenced by social support, and significantly reduce the quality of life (QOL) among survivors....

Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically...

Background Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients can be overlooked in health systems. Essential and Emergency Care (EECC) has been devised as the care that should be provided to all critically ill patients...

Introduction: Triage is an important component of in-hospital trauma care for adequate patient management and to avoid overcrowding in emergency departments (ED). Prioritising the evaluation of non-urgent patients may result in the diversion of workforce from patients requiring immediate care. However, not evaluating these patients may result in mi...