Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda

Kakembo, Nasser; Godier-Furnémont, Amandine; Nabirye, Ann; Cheung, Maija; Kisa, Phyllis; Muzira, Arlene; Sekabira, John; Ozgediz, Doruk

doi:10.1016/j.jss.2019.03.058

Cited by 39 publications

(31 citation statements)

References 23 publications

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“…Viewing these delays through the three-delay framework allows for identification of interventions to reduce delays in seeking antenatal care and reaching or receiving needed obstetric care [4]. This framework has been applied to define barriers to maternal health as well as surgical care for general populations in LMICs [5], but has not specifically been used to measure delays in surgical care for children, who have unique preoperative, perioperative, and postoperative needs. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions [16][17][18][19], 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 at all levels.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework

Concepcion

Dahir²,

Mohamed

et al. 2020

World j. surg.

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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.

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Section: Discussionmentioning

confidence: 99%

Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework

Concepcion

Dahir²,

Mohamed

et al. 2020

World j. surg.

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“…A number of factors (geopolitical, cultural, economic/financial, workforce) influence the decision to seek attention for a urological anomaly (Table 1) contributing to the ‘Three Delays’ that patients encounter in accessing appropriate care [3].…”

Section: Access To Paediatric Urology In Ssamentioning

confidence: 99%

Paediatric urology inSub‐SaharanAfrica: challenges and opportunities

et al. 2022

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The need for paediatric urological care in low-and middle-income countries in sub-Saharan Africa (SSA) is enormous due to a burgeoning paediatric-aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long-term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high-and low-income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low-and high-income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource-poor environment and the involvement of trainees from both income settings can help perpetuate long-term collaborations.

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“…Barriers are experienced at three delay stages: 1) seeking; 2) reaching; and 3) receiving quality health care [ 1 ]. Various studies from LMICs have used the Three Delays Framework to show that people experience barriers at multiple stages in the care pathway resulting in delays to accessing surgical care [ 12–14 ]. For example, a study in Somaliland reported delays for children receiving or seeking surgical care were most prominent due to barriers such as no perceived need or seeking traditional health care [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Quene

Smith

Odland

et al. 2022

Global Health Action

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Background Surgical healthcare in South Africa is inequitable with a considerable lack of resources in the public health sector. Identifying barriers to care and creating research priorities to mitigate these barriers can contribute to strategic interventions to improve equitable access to quality surgical care. Objective To use the Four Delays Framework to map barriers to surgical care and identify priorities to achieve equitable and timely access to quality surgical care in South Africa. Methods A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care, and remaining in care) was used to identify barriers that occur at each delay and the top 10 priorities for intervention. Barriers were categorised into overarching themes and schematically mapped. Results Thirty-four stakeholders including health service users, health service providers, and community members participated in this exercise. In total, 34 barriers were identified with 73 connections to various delays. Specifically, 14 barriers were related to delays in seeking care, 11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28 were related to delays in remaining in care. The highest priority barriers across the delays were Lack of service provider’s knowledge, training and experience , and Limited surgical outreach . The barrier Lack of decentralised services was related to all four delays. Barriers were interconnected and potentially reinforcing. Conclusions This workshop is the first of its kind to generate evidence on the delays to surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers, and priority interventions demonstrated how a multifaceted approach may be required to address delays to access. Further research focused on the identified priorities will contribute to efforts to promote equitable access to quality surgical care in South Africa.

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Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda

Cited by 39 publications

References 23 publications

Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework

Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework

Paediatric urology inSub‐SaharanAfrica: challenges and opportunities

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

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