Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 7/2013

01-07-2013

Disparities in Access to Surgical Care within a Lower Income Country: An Alarming Inequity

Authors: Syed Nabeel Zafar, Zafar Fatmi, Aftab Iqbal, Roomasa Channa, Adil H. Haider

Published in: World Journal of Surgery | Issue 7/2013

Login to get access

Abstract

Background

Surgical care is not uniformly available worldwide. Inequities in surgical care and access may also vary within countries, and the present study aimed to explore these disparities in Pakistan.

Methods

The National Health Survey of Pakistan was analyzed. The proportion of people with a history of abdominal surgery (AS) was calculated and associated factors were determined by weighted multivariate logistic regression. Factors tested were age, gender, urban/rural residence, province, literacy, community development index (CDI), and economic status (ES). The CDI was developed for each sampling unit from select household and individual data. The ES was constructed from ownership of assets.

Results

A total of 59 million adults were represented. Abdominal surgery had been performed in 3.2 % adults (95 % confidence interval [CI] = 2.67, 3.84), which corresponded to an annual rate of 85.9 abdominal surgeries per 100,000 population. Wide disparities were noted, with annual rates of AS varying from 37.8 to 215.6 per 100,000 population. Urban residents were independently twice as likely as rural populations to have had AS (95 % CI = 1.3, 2.8). Higher age (OR = 2.6; 95 % CI = 1.7, 4.0), female gender (OR = 1.5; 95 % CI = 1.1, 2.1), and higher ES (OR = 1.9; 95 % CI = 1.2, 2.9) were also independently associated with AS. In rural populations ES was the only factor associated with surgery, whereas in urban populations gender and CDI had important roles to play.

Conclusions

Access to surgical care is disparate and grossly inadequate in Pakistan. This likely contributes to significant preventable morbidity and death. Physical access to surgical facilities, especially in rural areas and for those with a low CDI, is an important concern and should be prioritized in any forthcoming national policies.
Literature
1.
Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Dean JGB, Jamison T, Measham AR (eds) Disease control priorities in developing countries. Oxford University Press, New York, pp 1245–1259
2.
3.
McCord C, Chowdhury QA (2003) Cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81:83–92CrossRefPubMed
4.
Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144CrossRefPubMed
5.
6.
Kushner AL, Cherian MN, Noel L et al (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145:154–159CrossRefPubMed
7.
8.
Fiscella K, Franks P, Doescher MP et al (2002) Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care 40:52–59CrossRefPubMed
9.
Hall SE, Holman CD, Sheiner H (2004) The influence of socio-economic and locational disadvantage on patterns of surgical care for lung cancer in Western Australia 1982–2001. Aust Health Rev 27:68–79CrossRefPubMed
10.
Ronsmans C, Holtz S, Stanton C (2006) Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet 368:1516–1523CrossRefPubMed
11.
Abdullah F, Choo S, Hesse AA et al (2011) Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews. J Surg Res 171:461–466CrossRefPubMed
12.
Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127 (discussion 128)CrossRefPubMed
13.
Ahmed M, Shah M, Luby S et al (1999) Survey of surgical emergencies in a rural population in the northern areas of Pakistan. Trop Med Int Health 4:846–857CrossRefPubMed
14.
National Institute of Population Studies (NIPS) (2008) Pakistan demographic health survey, 2006–2007. National Institute of Population Studies (NIPS) [Pakistan], Macro International Inc, Islamabad
15.
Pakistan Medical Research Council (1998) National health survey of Pakistan. Health profile of the people of Pakistan 1990–1994. Service NP, Islamabad
16.
Fatmi Z, Hadden WC, Razzak JA et al (2007) Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the national health survey of Pakistan 1990–1994. BMC Public Health 7:152CrossRefPubMed
17.
Fatmi Z, Kazi A, Hadden WC et al (2009) Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the national health survey of Pakistan. Paediatr Perinatal Epidemiol 23:229–238CrossRef
18.
Pappas G, Akhtar T, Gergen PJ et al (2001) Health status of the Pakistani population: a health profile and comparison with the United States. Am J Public Health 91:93–98CrossRefPubMed
19.
Hadden WC, Pappas G, Khan AQ (2003) Social stratification, development and health in Pakistan: an empirical exploration of relationships in population-based national health examination survey data. Soc Sci Med 57:1863–1874CrossRefPubMed
20.
Paquette IM, Zuckerman R, Finlayson SR (2011) Perforated appendicitis among rural and urban patients: implications of access to care. Ann Surg 253:534–538CrossRefPubMed
21.
22.
Siddiqi S, Kielmann A, Khan M et al (2001) The effectiveness of patient referral. Pak Health Policy Plan 16:193–198CrossRef
23.
Kadir MM, Khan A, Sadruddin S et al (2000) Out-of-pocket expenses borne by the users of obstetric services at government hospitals in Karachi, Pakistan. J Pak Med Assoc 50:412–415PubMed
24.
Shaikh BT, Hatcher J (2005) Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health 27:49–54CrossRef
25.
Buor D (2003) Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana. Int J Health Plan Manag 18:293–311CrossRef
26.
Gabrysch S, Cousens S, Cox J et al (2011) The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 8:e1000394CrossRefPubMed
27.
Penfold RB, Chisolm DJ, Nwomeh BC et al (2008) Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001–2003. Int J Health Geogr 7:56CrossRefPubMed
28.
Hasan IJ, Khanum A (2000) Health care utilization during terminal child illness in squatter settlements of Karachi. J Pak Med Assoc 50:405–409PubMed
29.
Yamasaki-Nakagawa M, Ozasa K, Yamada N et al (2001) Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuber Lung Dis 5:24–31
30.
McIntyre D, Thiede M, Birch S (2009) Access as a policy-relevant concept in low- and middle-income countries. Health Econ Policy Law 4:179–193CrossRefPubMed
31.
Akram M, Khan FJ (2007) Health care services and government spending in Pakistan. In: PIDE working papers, Pakistan Institute of Developmental Econonics, Islamabad
32.
Metadata
Title
Disparities in Access to Surgical Care within a Lower Income Country: An Alarming Inequity
Authors
Syed Nabeel Zafar
Zafar Fatmi
Aftab Iqbal
Roomasa Channa
Adil H. Haider
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 7/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1732-8

Other articles of this Issue 7/2013

World Journal of Surgery 7/2013 Go to the issue

OriginalPaper

Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

OriginalPaper

An Assessment of the Hospital Disease Burden and the Facilities for the In-hospital Care of Trauma in KwaZulu-Natal, South Africa

OriginalPaper

The Role of Unilateral Adrenalectomy in Corticotropin-Independent Bilateral Adrenocortical Hyperplasias

OriginalPaper

Notch1 Contributes to Chemoresistance to Gemcitabine and Serves as an Unfavorable Prognostic Indicator in Pancreatic Cancer

OriginalPaper

The Implementation of a Pilot Femur Fracture Registry at Komfo Anokye Teaching Hospital: An Analysis of Data Quality and Barriers to Collaborative Capacity-Building

OriginalPaper

Designing a Contextually Appropriate Surgical Training Program in Low-resource Settings: The Botswana Experience