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World Journal of Surgery
Published in: World Journal of Surgery 3/2020

01-03-2020 | Hypospadia | Surgery in Low and Middle Income Countries

Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland

Authors: Emily R. Smith, Tessa L. Concepcion, Mark Shrime, Kelli Niemeier, Mubarak Mohamed, Shugri Dahir, Edna Adan Ismail, Dan Poenaru, Henry E. Rice, the Global Initiative for Children’s Surgery

Published in: World Journal of Surgery | Issue 3/2020

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Abstract

Background

Delayed access to surgical care for congenital conditions in low- and middle-income countries is associated with increased risk of death and life-long disabilities, although the actual burden of delayed access to care is unknown. Our goal was to quantify the burden of disease related to delays to surgical care for children with congenital surgical conditions in Somaliland.

Methods

We collected data from medical records on all children (n = 280) receiving surgery for a proxy set of congenital conditions over a 12-month time period across all 15 surgically equipped hospitals in Somaliland. We defined delay to surgical care for each condition as the difference between the ideal and the actual ages at the time of surgery. Disability-adjusted life years (DALYs) attributable to these delays were calculated and compared by the type of condition, travel distance to care, and demographic characteristics.

Results

We found long delays in surgical care for these 280 children with congenital conditions, translating to a total of 2970 attributable delayed DALYs, or 8.4 avertable delayed DALYs per child, with the greatest burden among children with neurosurgical and anorectal conditions. Over half of the families seeking surgical care had to travel over 2 h to a surgically equipped hospital in the capital city of Hargeisa.

Conclusions

Children with congenital conditions in Somaliland experience substantial delays to surgical care and travel long distances to obtain care. Estimating the burden of delayed surgical care with avertable delayed DALYs offers a powerful tool for estimating the costs and benefits of interventions to improve the quality of surgical care.
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Metadata
Title
Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland
Authors
Emily R. Smith
Tessa L. Concepcion
Mark Shrime
Kelli Niemeier
Mubarak Mohamed
Shugri Dahir
Edna Adan Ismail
Dan Poenaru
Henry E. Rice
the Global Initiative for Children’s Surgery
Publication date
01-03-2020
Publisher
Springer International Publishing
Keywords
Hypospadia
Care
Published in
World Journal of Surgery / Issue 3/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05239-w

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