Emily R Smith1,2, Tessa L Concepcion3, Mark Shrime4,5, Kelli Niemeier6, Mubarak Mohamed7, Shugri Dahir7, Edna Adan Ismail7, Dan Poenaru8, Henry E Rice3. 1. Duke Global Health Institute, Duke University, Durham, NC, USA. Emily_r_smith@baylor.edu. 2. Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA. Emily_r_smith@baylor.edu. 3. Duke Global Health Institute, Duke University, Durham, NC, USA. 4. Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. 5. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. 6. Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA. 7. Edna Adan University Hospital, Hargeisa, Somaliland, Somalia. 8. McGill University, Montreal, QC, Canada.
Abstract
BACKGROUND: Delayed access to surgical care for congenital conditions in low- and middle-income countries is associated with increased risk of death and life-long disabilities, although the actual burden of delayed access to care is unknown. Our goal was to quantify the burden of disease related to delays to surgical care for children with congenital surgical conditions in Somaliland. METHODS: We collected data from medical records on all children (n = 280) receiving surgery for a proxy set of congenital conditions over a 12-month time period across all 15 surgically equipped hospitals in Somaliland. We defined delay to surgical care for each condition as the difference between the ideal and the actual ages at the time of surgery. Disability-adjusted life years (DALYs) attributable to these delays were calculated and compared by the type of condition, travel distance to care, and demographic characteristics. RESULTS: We found long delays in surgical care for these 280 children with congenital conditions, translating to a total of 2970 attributable delayed DALYs, or 8.4 avertable delayed DALYs per child, with the greatest burden among children with neurosurgical and anorectal conditions. Over half of the families seeking surgical care had to travel over 2 h to a surgically equipped hospital in the capital city of Hargeisa. CONCLUSIONS: Children with congenital conditions in Somaliland experience substantial delays to surgical care and travel long distances to obtain care. Estimating the burden of delayed surgical care with avertable delayed DALYs offers a powerful tool for estimating the costs and benefits of interventions to improve the quality of surgical care.
BACKGROUND: Delayed access to surgical care for congenital conditions in low- and middle-income countries is associated with increased risk of death and life-long disabilities, although the actual burden of delayed access to care is unknown. Our goal was to quantify the burden of disease related to delays to surgical care for children with congenital surgical conditions in Somaliland. METHODS: We collected data from medical records on all children (n = 280) receiving surgery for a proxy set of congenital conditions over a 12-month time period across all 15 surgically equipped hospitals in Somaliland. We defined delay to surgical care for each condition as the difference between the ideal and the actual ages at the time of surgery. Disability-adjusted life years (DALYs) attributable to these delays were calculated and compared by the type of condition, travel distance to care, and demographic characteristics. RESULTS: We found long delays in surgical care for these 280 children with congenital conditions, translating to a total of 2970 attributable delayed DALYs, or 8.4 avertable delayed DALYs per child, with the greatest burden among children with neurosurgical and anorectal conditions. Over half of the families seeking surgical care had to travel over 2 h to a surgically equipped hospital in the capital city of Hargeisa. CONCLUSIONS:Children with congenital conditions in Somaliland experience substantial delays to surgical care and travel long distances to obtain care. Estimating the burden of delayed surgical care with avertable delayed DALYs offers a powerful tool for estimating the costs and benefits of interventions to improve the quality of surgical care.
Authors: Tessa L Concepcion; Shukri Dahir; Mubarak Mohamed; Kyle Hiltbrunn; Edna Adan Ismail; Dan Poenaru; Henry E Rice; Emily R Smith Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Paul Truche; Emily R Smith; Adesoji Ademuyiwa; Alexandra Buda; Mary T Nabukenya; Neema Kaseje; Emmanuel A Ameh; Sarah Greenberg; Faye Evans; Stephen Bickler; John G Meara; Henry E Rice Journal: World J Surg Date: 2022-06-25 Impact factor: 3.282
Authors: Shukri Dahir; Cesia F Cotache-Condor; Tessa Concepcion; Mubarak Mohamed; Dan Poenaru; Edna Adan Ismail; Andy J M Leather; Henry E Rice; Emily R Smith Journal: BMJ Open Date: 2020-12-29 Impact factor: 2.692
Authors: Marlon Leonardo Silva-Rued; Alejandro Ramírez-Romero; Luis Rene Guerra-Maestre; Ángela María Forero-Hollmann; Ivan David Lozada-Martínez Journal: Int J Surg Date: 2021-07-30 Impact factor: 6.071