Quantifying delays and self-identified barriers to timely access to pediatric surgery at Mbarara Regional Referral Hospital, Uganda

Abstract

PurposeFavorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility. MethodsAn 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. ResultsThe 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%. ConclusionsCare-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 EvidenceLevel II.