The study, led by O. A. Elebute of the Department of Surgery at the College of Medicine, University of Lagos, together with a multidisciplinary team spanning Lagos University Teaching Hospital, Duke University, Baylor University, the University of Edinburgh, McGill University and Nationwide Children’s Hospital, deployed the Surgeons OverSeas Assessment of Surgical Need, or SOSAS, tool. SOSAS is a structured household questionnaire designed specifically to measure the burden of surgical disease in low- and middle-income countries, where hospital records capture only a fraction of the true disease landscape. In 2016, the team surveyed 856 households in Ikorodu Local Government Area, covering 3,984 individuals: 1,986 adult informants answering on their own behalf and 1,998 children represented through parental or guardian responses.

The survey’s design reflected a deliberate conservatism. Disability was recorded only when an informant explicitly attributed functional impairment to a surgical condition, rather than allowing interviewers to infer it. Mortality questions covered the twelve months preceding the interview, and for the 43 deaths for which individual age data were available, the researchers calculated years of life lost, or YLL, using the World Health Organization’s 2015 life table for Nigeria. This metric, a cornerstone of the Global Burden of Disease framework, quantifies the gap between the age at death and the age to which a person could have expected to live under standard mortality conditions.

What the team found was striking in its asymmetry. Forty-six deaths were reported across the surveyed population, 32 among adults and 14 among children, but for 36 of those deaths, 78.3 percent, the cause could not be ascertained. The crude all-cause death rate stood at 11.5 per 1,000 persons, with a 95 percent confidence interval of 8.7 to 15.4. The total years of life lost amounted to 1,681.3 years, averaging 39.1 years per death, a figure that underscores how much potential life is extinguished when people die young in a community where life expectancy is already constrained.

On the morbidity side, the survey catalogued 169 classified pathology entries among adults, and the dominant category was unexpected to some observers: conditions of the extremities, meaning disorders of the arms and legs, accounted for 91 entries, or 53.8 percent of all classified surgical pathology. This finding aligns with a growing recognition in global surgery research that musculoskeletal problems, from untreated fractures to chronic infections and deformities, represent an enormous and underappreciated share of surgical need in resource-limited settings, where road traffic injuries and occupational hazards are common and orthopedic capacity is thin.

Yet the disability data told a quieter story. Only 20 adults, or 1.0 percent of the adult sample, and 4 children, or 0.2 percent of the child sample, reported perceived disability attributable to a surgical condition. When the researchers ran an exploratory calculation of years lived with disability, or YLD, using representative disability weights and a conservative one-year duration assumption for affected respondents, the total came to just 1.55 years. Combining this with the mortality burden produced a total of 1,682.9 disability-adjusted life years, or DALYs, equivalent to 422.4 per 1,000 persons. More than 99 percent of that total consisted of years of life lost rather than years lived with disability.

This overwhelming dominance of mortality over morbidity in the DALY calculation is the study’s most consequential technical finding, and the authors are careful to explain why it demands caution rather than celebration. Because 78.3 percent of reported deaths had unascertained causes, the team could not estimate any surgically attributable mortality at all. The DALY figure therefore represents a floor, not a ceiling, for the community’s surgical disease burden. If any of those 36 unexplained deaths were caused by surgically treatable conditions, such as strangulated hernias, obstructed labor, appendicitis, or trauma, the true surgical share of the burden would be higher than the study could detect. Household informants, even when cooperative and well-intentioned, often cannot reconstruct the biomedical cause of a death that occurred months earlier, particularly in settings where many people die at home without formal medical certification.

The low rate of perceived disability raises a parallel methodological question. The SOSAS tool’s strict criterion, requiring informants to explicitly link functional impairment to a surgical condition, is designed to avoid inflating estimates, but it may also undercount disability in communities where chronic limitations are normalized, attributed to other causes, or simply not framed in terms of surgery. A person living with an untreated clubfoot, a chronic burn contracture, or a painful hernia that limits heavy labor may not spontaneously identify their condition as a surgical problem, even though a surgeon would recognize it as one. Cross-national SOSAS studies in Sierra Leone, Nepal, and Uganda have reported higher disability prevalence, suggesting that local framing, awareness, and stigma all shape what households are willing or able to report.

For the researchers, the policy implications are clear even amid the data limitations. The findings support improved access to timely surgical care, stronger referral pathways that can move patients from community health posts to facilities with operating capacity, and, critically, better community mortality surveillance. Without reliable cause-of-death information, planners cannot know how many deaths in a given year were preventable through surgery, and the global movement to embed surgical care within universal health coverage, championed by the Lancet Commission on Global Surgery, depends on exactly this kind of population-level evidence. The 422.4 DALYs per 1,000 persons measured in Ikorodu, even as a conservative lower bound, provides a benchmark against which future interventions, from trauma system development to hernia repair campaigns, can be evaluated.

The study also carries a broader lesson for the science of measuring unmet surgical need. Household surveys like SOSAS are among the few tools capable of reaching populations that never present to hospitals, and their findings repeatedly reveal that the burden of surgical disease in low-resource settings is far larger than operative logs suggest. But this Lagos survey demonstrates that the same instruments face real constraints: mortality attribution is fragile, disability perception is culturally mediated, and conservative assumptions can dramatically compress estimated burden. The authors’ call for community mortality surveillance, systems that systematically record and verify deaths and their causes at the neighborhood level, is thus not merely a technical recommendation but a prerequisite for understanding whether surgical care, one of the most cost-effective interventions in medicine, is reaching the people who die without it. In Ikorodu, as in much of the world, the silent toll of untreated surgical conditions remains largely uncounted, and this study is a step toward making the invisible visible.

Subject of Research: Population-level burden of untreated surgical conditions, mortality and disability in Lagos, Nigeria

Article Title: 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

Article References: Elebute, O. A., Odugbemi, T. O., Bankole, O. B., Makanjuola, A., Alabi, E. O., Abazie, O., Ademuyiwa, I. Y., Okusanya, B., Onwuka, A., Smith, E. R., Tran, T., Gupta, S., Ots, R., Harrison, E. M., Poenaru, D., Seyi-Olajide, J. O., Ladipo-Ajayi, O., Alakaloko, F. M., Bode, C. O., … Ademuyiwa, A. O. (2026). 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. BMC Public Health. https://doi.org/10.1186/s12889-026-29936-z

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29936-z

Keywords: global surgery, SOSAS survey, Nigeria, Lagos, surgical conditions, years of life lost, disability-adjusted life years, household survey, public health, low- and middle-income countries, mortality surveillance, disability

The analysis, published in Public Health in Practice, was conducted by Michael J. Tipton of the University of Portsmouth and colleagues, including Carlene McAvoy, Paddy Morgan and Martin J. Barwood. Rather than simply counting deaths, the team adopted a framework borrowed from the Global Burden of Disease project: Years of Life Lost, or YLL. This metric weights each death by how much longer the person could have been expected to live had they not died prematurely. Because drowning disproportionately claims the young, a raw death toll dramatically understates its impact. A drowning at twenty erases more than sixty potential years; a death at eighty-five erases only a handful. YLL makes that asymmetry visible.

To build the picture, the researchers turned to the UK’s Water Incident Database, known as WAID, the country’s primary repository for drowning fatalities and one that has been independently validated as meeting the World Health Organization’s data quality requirements. They focused on 2023, the most recent comprehensive and audited year of data, and checked that it was representative: fatalities classified as suspected accidents and suspected suicides — the majority of database entries — fell within one standard deviation of the preceding three-year average. Population figures and sex-specific life expectancy tables came from the Office for National Statistics, using three-year rolling averages for 2022 to 2024.

The method itself was straightforward but demanding. Each fatality was assigned to a ten-year age band, the midpoint of that band was subtracted from the sex-specific national life expectancy of the relevant home nation, and the result was multiplied by the number of deaths in that group. Calculations were performed separately for England, Scotland, Wales and Northern Ireland, then aggregated to a UK total. To convert the loss of years into money, the team applied the UK Treasury’s Green Book valuation, which sets the monetary value of a statistical life year at £60,000 — the standard figure used across UK public health economics to weigh the benefits of preventive interventions.

The results reveal the anatomy of the burden. Accidental drownings accounted for 7,755 years of life lost, worth £465 million; suspected suicides contributed 4,867 years, valued at £292 million; deaths classified as inconclusive added 2,829 years and £170 million; and water-related deaths from crime contributed a further 106 years. England bore by far the largest share, with 11,575 years lost and an economic burden of £694 million, followed by Scotland at £113 million, Wales at £96 million and Northern Ireland at £30 million. The differences between nations reflect both the number of fatalities and variations in local life expectancy.

Perhaps the most provocative finding is what the comparison implies. Conditions that dominate headlines and health budgets, judged by death counts, may in fact steal fewer years of life than drowning, a cause of death the public rarely ranks among urgent priorities. Globally, the picture is similar: burden-of-disease analyses rank drowning as the second-largest contributor to years of life lost from unintentional injuries, behind only road traffic injuries. In the UK, at least 659 people died by drowning or water-related fatality in 2023, a typical annual figure, with 5,051 lives lost between 2012 and 2019 — most from accidents, and roughly a third from suicide.

The study is also among the first to quantify the financial weight of intentional drowning. This is a growing concern internationally, with rescue agencies increasingly called to respond to people threatening self-harm in water. The authors note that the causes of intentional drowning likely differ from those of accidental drowning, demanding distinct prevention strategies, and that the psychological toll on rescuers who attend such incidents is significant. Suicide-related drowning alone costs the UK an estimated £292 million each year in lost life years — a figure that reframes water safety as a mental health issue as much as a recreational one.

Climate change threatens to make the problem worse. As an island nation threaded with thousands of miles of inland and coastal waterways, the UK already offers abundant exposure to open water, and warming temperatures are expanding both the opportunities and the temptations. Previous UK research using national fatality data found that each 1°C rise in ambient temperature above 15°C increases drowning frequency by 7.2 percent — a figure that climbs to 22 percent when alcohol intoxication is suspected. Drowning fatalities are three to seven times higher on days exceeding 25°C than on days that never reach 10°C. With heatwaves and flooding both projected to intensify, the authors call for disaster risk management policies and national weather alert systems explicitly linked to drowning risk.

The £933 million figure is, if anything, an underestimate. The analysis covers only fatal drownings, because the UK lacks a robust national dataset on non-fatal incidents and their long-term consequences. Evidence from Australia suggests the relationship between fatal drownings and drowning-related hospitalisations is roughly one to 2.71, meaning the true burden of disability and morbidity is far larger than deaths alone suggest. A study of critical care admissions in South-West England over eleven years recorded 49 drowning admissions, of which about 35 percent died, 20 percent had ongoing care needs, and three patients required full-time care for daily living — with lifetime care costs for those three alone estimated at £6.4 million, on top of pre-hospital costs of £51,716 and hospital costs of £317,373. Search, rescue and treatment costs were excluded from the national calculation for lack of comprehensive data, but are likely to be substantial.

The economic case for action is compelling. The World Health Organization estimates that increased investment in drowning prevention could save 774,000 children’s lives worldwide, prevent nearly one million non-fatal drownings and avert more than 400 billion US dollars in economic losses by 2050 — with an estimated return of nine dollars for every dollar invested. The researchers argue that prevention requires senior political representation, better data to target interventions, curriculum-based water safety education covering rescue and resuscitation skills, engineered barriers at high-risk locations, legislation regulating alcohol consumption near water, and a well-resourced National Water Safety Forum. Drowning, they conclude, is a largely preventable cause of death whose personal, social and financial burden can be reduced with wide-ranging benefits — and the nearly one billion pound annual price tag makes the case impossible to ignore.

Subject of Research: The years of life lost and economic costs of unintentional and intentional drowning in the United Kingdom

Article Title: Quantifying the costs of unintentional and intentional drowning in the United Kingdom: A secondary data analysis study

Article References: Tipton, M. J., McAvoy, C., Morgan, P., & Barwood, M. J. (2026). Quantifying the costs of unintentional and intentional drowning in the United Kingdom: A secondary data analysis study. Public Health in Practice, 12, Article 100866. https://doi.org/10.1016/j.puhip.2026.100866

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100866

Keywords: drowning, years of life lost, public health, United Kingdom, suicide prevention, water safety, economic burden, climate change, WAID, injury prevention, life expectancy, drowning prevention

The research team, led by Chotimas Thaigaroen and Arthit Phosri, examined six pollutants: fine particulate matter known as PM2.5, which measures 2.5 microns or less in diameter; coarser particulate matter known as PM10; nitrogen dioxide; sulfur dioxide; ozone; and carbon monoxide. Each of these pollutants has distinct sources and health pathways. PM2.5 and PM10, which in Thailand are heavily influenced by agricultural biomass burning, traffic, and industrial emissions, penetrate deep into the lungs and can even enter the bloodstream, triggering systemic inflammation. Nitrogen dioxide and carbon monoxide arise largely from vehicle exhaust, while sulfur dioxide stems from industrial combustion, and ozone forms secondarily when sunlight reacts with precursor gases in urban air.

Methodologically, the study used a case-crossover design, a technique in which each person who died serves as their own control. Pollutant levels on the day of death, or in the days immediately preceding it, were compared with pollutant levels on nearby days when the same individual was still alive. This design elegantly controls for individual characteristics such as age, smoking history, and underlying disease that could otherwise confound the results. The researchers applied conditional Poisson regression to estimate province-specific effects of pollution on mortality risk, and used a Gaussian regression model to quantify relationships with years of life lost, a metric that weights each death by how much expected lifespan was cut short. Province-level estimates were then pooled through a random-effects meta-analysis to produce robust nationwide figures.

The findings are striking. An interquartile range increase in PM10 over a moving window of zero to three days was associated with a 4.12 percent increase in the risk of death from all causes, with a 95 percent confidence interval spanning 2.93 to 5.33 percent. Fine particulate matter, PM2.5, showed a similarly powerful effect: an interquartile increase at lag 0–3 raised mortality risk by 3.90 percent. Ozone was linked to a 2.99 percent increase in mortality risk. The remaining pollutants were analyzed over a shorter two-day window, and nitrogen dioxide emerged as the single most potent pollutant in the study, associated with a 6.57 percent jump in all-cause mortality risk per interquartile increase. Sulfur dioxide and carbon monoxide raised mortality risk by 2.00 percent and 3.59 percent, respectively. Every single pollutant examined produced a statistically significant increase in death risk.

Mortality counts, however, tell only part of the story. The study’s second major contribution is its use of years of life lost, or YLL, an epidemiological measure that captures the full burden of premature death rather than simply tallying fatalities. Because pollution-related deaths tend to occur disproportionately among older adults, one might assume the lost lifespan is modest. The data suggest otherwise. An interquartile increase in PM10 was associated with 12.4 additional years of life lost per day nationwide, while PM2.5 spikes added 11.5 years of lost life. Nitrogen dioxide, again the most damaging pollutant in relative terms, was linked to 21.1 additional years of life lost. Ozone contributed 8.3 years, carbon monoxide 9.1 years, and sulfur dioxide 6.4 years. These numbers translate pollution concentrations, typically invisible to the public, into a tangible currency of human lifespan.

The biological plausibility of these associations rests on decades of mechanistic research. Fine particles deposit in the alveolar regions of the lung, where they provoke oxidative stress and inflammatory cascades that extend well beyond the respiratory system. Inhaled pollutants are known to activate the sympathetic nervous system, raise blood pressure, promote blood coagulation, and destabilize atherosclerotic plaques, creating a direct pathway to heart attacks and strokes within hours or days of exposure. Nitrogen dioxide and ozone irritate and inflame the airway lining, worsening chronic obstructive pulmonary disease and asthma. Carbon monoxide binds to hemoglobin with an affinity more than two hundred times greater than oxygen, effectively suffocating tissues, while sulfur dioxide has been shown in animal models to impair cardiac and mitochondrial function and to aggravate airway inflammation through reactive oxygen species pathways.

Thailand presents a particularly important setting for this kind of research. The country experiences severe seasonal haze, especially in its northern provinces, driven by the burning of crop residues and forests during the dry season, alongside chronic urban pollution from the Bangkok metropolitan region’s dense traffic. Previous Thai studies, including earlier work by members of this research team, had documented links between pollution and hospital admissions in Bangkok, but national-scale evidence connecting short-term exposure to both mortality and life-years lost had been limited. The new study, drawing on data from the Pollution Control Department, the Thai Meteorological Department, and the Ministry of Public Health, closes that gap and confirms that the acute dangers of polluted air extend across urban and rural Thailand alike.

The findings also align with a growing international literature. Nationwide analyses in China, covering hundreds of cities, have produced comparable estimates for PM2.5 and ozone, and systematic reviews and meta-analyses have repeatedly confirmed that even concentrations below many regulatory thresholds carry measurable mortality risk. What sets the Thai study apart is its dual endpoint: by reporting both percent increases in mortality risk and absolute years of life lost, it gives policymakers two complementary tools. Percent risk changes speak to epidemiologists and regulators, while years of life lost translate directly into the social and economic cost of pollution, a framing that tends to resonate more strongly with the public and with elected officials weighing the price of cleaner air against the price of inaction.

The implications for policy are immediate. The authors argue that their findings provide robust national evidence to inform air quality management strategies and to support public health policies aimed at reducing premature mortality and disease burden. Practically, that means strengthening daily air quality warnings, integrating health risk into air quality indices, targeting agricultural burning seasons with enforcement and alternatives for farmers, and accelerating reductions in traffic emissions. Because the effects were observed over lags of just two to four days, the study also underscores the value of rapid-response measures: when pollution forecasts spike, advising vulnerable populations to stay indoors, expanding access to filtration, and temporarily curbing emission sources could save lives within days. As the researchers conclude, every avoidable increment of pollution represents measurable human lifespan lost, and the evidence from Thailand now makes that cost impossible to ignore.

Subject of Research: Short-term effects of ambient air pollution on mortality and years of life lost in Thailand

Article Title: Short-term effects of ambient air pollution on mortality and years of life lost in Thailand

Article References: Thaigaroen, C., Phosri, A., Sihabut, T., & Patthanaissaranukool, W. (2026). Short-term effects of ambient air pollution on mortality and years of life lost in Thailand. Air Quality, Atmosphere & Health, 19(9), Article 200. https://doi.org/10.1007/s11869-026-02093-3

Image Credits: AI Generated

DOI: 10.1007/s11869-026-02093-3

Keywords: air pollution, PM2.5, PM10, nitrogen dioxide, ozone, mortality, years of life lost, Thailand, case-crossover study, public health, environmental epidemiology, air quality