Tessa L Concepcion1, Shukri Dahir2, Mubarak Mohamed2, Kyle Hiltbrunn3, Edna Adan Ismail2, Dan Poenaru4, Henry E Rice1, Emily R Smith5,6. 1. Duke Global Health Institute, Duke University, Durham, NC, USA. 2. Edna Adan University Hospital, Hargeisa, Somaliland. 3. Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1621 S. 5th Street, Waco, TX, 76706, USA. 4. McGill University, Montreal, QC, Canada. 5. Duke Global Health Institute, Duke University, Durham, NC, USA. Emily_R_Smith@baylor.edu. 6. Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1621 S. 5th Street, Waco, TX, 76706, USA. Emily_R_Smith@baylor.edu.
Abstract
BACKGROUND: There are complex barriers that increase delays to surgical care in low- and middle-income countries, particularly among the vulnerable population of children. Understanding these barriers to surgical care can result in targeted and strategic intervention efforts to improve care for children. The three-delay model is a widely used framework in global health for evaluating barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). The goal of our study is to evaluate reasons for delays in the surgical care for children in Somaliland using the three-delay framework. METHODS: Data were collected in a cross-sectional study in Somaliland from 1503 children through a household survey. Among children with a surgical need, we quantified the number of children seeking, reaching, and receiving care along the surgical care continuum, according to the three-delay framework. We evaluated predictors of the three delays through a multivariate logistic regression model, including the child's age, gender, village type, household income level, region, and household size. RESULTS: Of the 196 children identified with a surgical condition, 50 (27.3%) children had a delay in seeking care (D1), 28 (20.6%) children had a delay in reaching care (D2), and 84 (71.2%) children had a delay in receiving care (D3), including 10 children who also experienced D1 and D2. The main reasons cited for D1 included seeking a traditional healthcare provider, while lack of money and availability of care were main reasons cited for D2. Significant predictors for delays included household size for D1 and D3 and condition type and region for D2. CONCLUSION: Children in Somaliland experience several barriers to surgical care along the entire continuum of care, allowing for policy guidance tailored to specific local challenges and resources. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions, viewing delays in surgical care under the lens of the three-delay framework can inform strategic interventions along the pediatric surgical care continuum, thereby reducing delays and improving the quality of surgical care for children.
BACKGROUND: There are complex barriers that increase delays to surgical care in low- and middle-income countries, particularly among the vulnerable population of children. Understanding these barriers to surgical care can result in targeted and strategic intervention efforts to improve care for children. The three-delay model is a widely used framework in global health for evaluating barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). The goal of our study is to evaluate reasons for delays in the surgical care for children in Somaliland using the three-delay framework. METHODS: Data were collected in a cross-sectional study in Somaliland from 1503 children through a household survey. Among children with a surgical need, we quantified the number of children seeking, reaching, and receiving care along the surgical care continuum, according to the three-delay framework. We evaluated predictors of the three delays through a multivariate logistic regression model, including the child's age, gender, village type, household income level, region, and household size. RESULTS: Of the 196 children identified with a surgical condition, 50 (27.3%) children had a delay in seeking care (D1), 28 (20.6%) children had a delay in reaching care (D2), and 84 (71.2%) children had a delay in receiving care (D3), including 10 children who also experienced D1 and D2. The main reasons cited for D1 included seeking a traditional healthcare provider, while lack of money and availability of care were main reasons cited for D2. Significant predictors for delays included household size for D1 and D3 and condition type and region for D2. CONCLUSION:Children in Somaliland experience several barriers to surgical care along the entire continuum of care, allowing for policy guidance tailored to specific local challenges and resources. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions, viewing delays in surgical care under the lens of the three-delay framework can inform strategic interventions along the pediatric surgical care continuum, thereby reducing delays and improving the quality of surgical care for children.
Authors: Tessa L Concepcion; Emily R Smith; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Andrew J M Leather; Dan Poenaru; Henry E Rice Journal: World J Surg Date: 2019-11 Impact factor: 3.352
Authors: Jihad Abdelgadir; Maria Punchak; Emily R Smith; Aaron Tarnasky; Alex Muhindo; Joao Ricardo Nickenig Vissoci; Michael M Haglund; David Kitya Journal: J Clin Neurosci Date: 2017-10-20 Impact factor: 1.961
Authors: Emily R Smith; Tessa Concepcion; Stephanie Lim; Sam Sadler; Dan Poenaru; Anthony T Saxton; Mark Shrime; Emmanuel Ameh; Henry E Rice Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Emily R Smith; Brittney J van de Water; Anna Martin; Sarah Jean Barton; Jasmine Seider; Christopher Fitzgibbon; Mathama Malakha Bility; Nelia Ekeji; Joao Ricardo Nickenig Vissoci; Michael M Haglund; Janet Prvu Bettger Journal: BMC Health Serv Res Date: 2018-09-20 Impact factor: 2.655
Authors: Elissa K Butler; Tu M Tran; Anthony T Fuller; Alexa Brammell; Joao Ricardo Vissoci; Luciano de Andrade; Fredrick Makumbi; Samuel Luboga; Christine Muhumuza; Vincent F Ssennono; Jeffrey G Chipman; Moses Galukande; Michael M Haglund; Emily R Smith Journal: Pediatr Surg Int Date: 2016-09-10 Impact factor: 1.827
Authors: Tessa Concepcion; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Dan Poenaru; Henry E Rice; Emily R Smith Journal: JAMA Netw Open Date: 2019-01-04
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