Open AccessA Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study
Author(s) -
Philipo Godfrey Sama,
Bokhary Zaitun Mohamed,
Bayyo Neema Lala,
Bandyopadhyay Soham,
Pueschel Miriam Gerd,
Bakari Rajabu Athumani,
Lakhoo Kokila
Publication year - 2022
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-022-06530-z
Subject(s) - medicine , tanzania , observational study , cohort , family medicine , incidence (geometry) , health care , prospective cohort study , cohort study , descriptive statistics , emergency medicine , pediatrics , surgery , statistics , physics , environmental science , mathematics , environmental planning , optics , economics , economic growth
Background A majority of the 2 billion children lacking access to safe, timely and affordable surgical care reside in low‐and middle‐income countries. A barrier to tackling this issue is the paucity of information regarding children's journey to surgical care. We aimed to explore children's journeys and its implications on accessing general paediatric surgical care at Muhimbili National Hospital (MNH), a tertiary centre in Tanzania. Methods A prospective observational cohort study was undertaken at MNH, recruiting patients undergoing elective and emergency surgeries. Data on socio‐demographic, clinical, symptoms onset and 30‐days post‐operative were collected. Descriptive statistics and Mann–Whitney, Kruskal–Wallis and Fisher's exact tests were used for data analysis. Result We recruited 154 children with a median age of 36 months. The majority were referred from regional hospitals due to a lack of paediatric surgery expertise. The time taken to seeking care was significantly greater in those who self‐referred ( p = 0.0186). Of these participants, 68.4 and 31.1% were able to reach a referring health facility and MNH, respectively, within 2 h of deciding to seek care. Overall insurance coverage was 75.32%. The median out of pocket expenditure for receiving care was $69.00. The incidence of surgical site infection was 10.2%, and only 2 patients died. Conclusion Although there have been significant efforts to improve access to safe, timely and affordable surgical care, there is still a need to strengthen children's surgical care system. Investing in regional hospitals may be an effective approach to improve access to children surgical care.