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.
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| http://dx.doi.org/10.1016/j.jpedsurg.2018.02.045 | DOI Listing |
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