Rural and urban differences in treatment status among children with surgical conditions in Uganda.

Ashley Bearden,Vincent Ssennono,Christine Muhumuza,Moses Galukande,Samuel Luboga,Anthony T Fuller,Fredrick Makumbi,Emily R Smith,Michael Haglund,Tu Tran,Elissa K Butler,Leonidas G Koniaris

doi:10.1371/journal.pone.0205132

Abstract

BackgroundIn low and middle-income countries, approximately 85% of children have a surgically treatable condition before the age of 15. Within these countries, the burden of pediatric surgical conditions falls heaviest on those in rural areas. The objective of the current study was to evaluate the relationship between rurality, surgical condition and treatment status among a cohort of Ugandan children.MethodsWe identified 2176 children from 2315 households throughout Uganda using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey. Children were randomly selected and were included in the study if they were 18 years of age or younger and had a surgical condition. Location of residence, surgical condition, and treatment status was compared among children.ResultsOf the 305 children identified with surgical conditions, 81.9% lived in rural areas. The most prevalent causes of surgical conditions reported among rural and urban children were masses (24.0% and 25.5%, respectively), followed by wounds due to injury (19.6% and 16.4%, respectively). Among children with untreated surgical conditions, 79.1% reside in rural areas while 20.9% reside in urban areas. Among children with untreated surgical conditions, the leading reason for not seeking surgical care among children living in both rural and urban areas was a lack of money (40.6% and 31.4%, respectively), and the leading reason for not receiving care in both rural and urban settings was a lack of money (48.0% and 42.8%, respectively).ConclusionsOur data suggest that over half of the children with a surgical condition surveyed are not receiving surgical care and a large majority of children with surgical needs were living in rural areas. Future interventions aimed at increasing surgical access in rural areas in low-income countries are needed.

Highlights

5 billion do not have timely, safe, and affordable access to surgical care, with the highest estimated need in sub-Saharan Africa. [1, 2] The absence of surgical care in these regions lends to higher rates of morbidity and mortality as well as increased disability adjusted life years (DALYs).[3]
Of the 305 children identified with surgical conditions, 81.9% lived in rural areas
Among children with untreated surgical conditions, the leading reason for not seeking surgical care among children living in both rural and urban areas was a lack of money (40.6% and 31.4%, respectively), and the leading reason for not receiving care in both rural and urban settings was a lack of money (48.0% and 42.8%, respectively)

Summary

Introduction

5 billion do not have timely, safe, and affordable access to surgical care, with the highest estimated need in sub-Saharan Africa. [1, 2] The absence of surgical care in these regions lends to higher rates of morbidity and mortality as well as increased disability adjusted life years (DALYs).[3]. The surgical burden among children is great with approximately 10-85% of children in LMICs having a surgically treatable condition before the age of 15.[8] According to one study spanning across four LMICs (Rwanda, Uganda, Sierra Leone, and Nepal), the highest unmet surgical need among the pediatric population was due to head, face and neck conditions and one-third of all conditions were due to masses.[9] In addition, an estimated 303,000 children die within four weeks of birth due to congenital anomalies and many of these structural congenital anomalies could be treated with surgical care.[10] throughout Sub-Saharan Africa, many children lack access to surgical care, leading to increased rates of life-long disability and mortality.[11] Within Uganda, the site of the current study, approximately 1.3 million children currently have an untreated surgical condition, with the highest need in the rural Northern and Western regions.[12, 13]. The objective of the current study was to evaluate the relationship between rurality, surgical condition and treatment status among a cohort of Ugandan children.

Objectives

Results

Conclusion