Mercedes Pilkington1, Martin Situma2, Andrea Winthrop3, Dan Poenaru4. 1. Department of Surgery, Queen's University, Kingston, ON, Canada. Electronic address: 8mmap@queensu.ca. 2. Mbarara University Teaching Hospital, Mbarara University for Science and Technology, Mbarara, Uganda. 3. Department of Surgery, Queen's University, Kingston, ON, Canada. 4. Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Abstract
PURPOSE: Favorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility. METHODS: An interviewer-facilitated survey was administered over 8months to consecutive pediatric surgical families at Mbarara Regional Referral Hospital (MRRH). Delays were classified using the Three Delays Model: care-seeking, arrival at health facility, and from surgical consultation to surgery. Barriers at each stage were explored with caregivers. RESULTS: The survey included 174 patients. Family members were first to recognize disease in 90%, but only 14% sought medical attention immediately. Delays in seeking care predominated (median 30days), mostly attributed to home treatments (51%) and other responsibilities (28%). After referral decision, 80% of caregivers brought their child to MRRH immediately (median time to arrival <24h). Upon MRRH arrival, 57% of patients were assessed the same day, and time to surgery was relatively short (median 4days). Despite free under-5 care, out-of-pocket payments (between $1-42 USD) were reported by 64%. CONCLUSIONS: Care-seeking delays dominate access to pediatric surgical care in Uganda, and cost remains a significant barrier. Primary provider education and advocacy for increased resources would be useful interventions to improve timeliness of pediatric surgical care. LEVEL OF EVIDENCE: Level II.
PURPOSE: Favorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility. METHODS: An interviewer-facilitated survey was administered over 8months to consecutive pediatric surgical families at Mbarara Regional Referral Hospital (MRRH). Delays were classified using the Three Delays Model: care-seeking, arrival at health facility, and from surgical consultation to surgery. Barriers at each stage were explored with caregivers. RESULTS: The survey included 174 patients. Family members were first to recognize disease in 90%, but only 14% sought medical attention immediately. Delays in seeking care predominated (median 30days), mostly attributed to home treatments (51%) and other responsibilities (28%). After referral decision, 80% of caregivers brought their child to MRRH immediately (median time to arrival <24h). Upon MRRH arrival, 57% of patients were assessed the same day, and time to surgery was relatively short (median 4days). Despite free under-5 care, out-of-pocket payments (between $1-42 USD) were reported by 64%. CONCLUSIONS: Care-seeking delays dominate access to pediatric surgical care in Uganda, and cost remains a significant barrier. Primary provider education and advocacy for increased resources would be useful interventions to improve timeliness of pediatric surgical care. LEVEL OF EVIDENCE: Level II.
Authors: Sarah Peiffer; Anna E Ssentongo; Laura Keeney; Forster Amponsah-Manu; Richard Yeboako; Richard Ofosu-Akromah; Temitope Ebenezer Arkorful; Eric Agyemang; Anthony Tsai; John Oh; Paddy Ssentongo Journal: BMC Surg Date: 2020-09-22 Impact factor: 2.102