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Barriers to Surgical Care and Health Outcomes: A Prospective Study on the Relation Between Wealth, Sex, and Postoperative Complications in the Republic of Congo

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Abstract

Background

Approximately thirty percent of the global burden of disease is comprised of surgical conditions. However, five billion people lack access to surgery, with complex factors acting as barriers. We examined whether patient demographics predict barriers to care, and the relation between these factors and postoperative complications in a prospective cohort.

Methods

Participants included people presenting to a global charity in Republic of Congo with a surgical condition between August 2013 and May 2014. The outcomes were self-reported barrier to care and postoperative complications documented by medical record. Logistic regression was used to adjust for covariates.

Results

Of 1237 patients in our study, 1190 (96.2 %) experienced a barrier to care and 126 (10.2 %) experienced a postoperative complication. The most frequently reported barrier was cost (73 %), followed by lack of provider (8.2 %). Greater wealth was associated with decreased odds of cost as a barrier (OR 0.72 [0.57, 0.90]). Greater wealth (OR 1.52 [1.03, 2.25]) and rural home location (OR 3.35 [1.16, 9.62]) were associated with increased odds of no surgeon being available. Cost as a barrier (OR 2.82 [1.02, 7.77]), female sex (OR 3.45 [1.62, 7.33]), and lack of surgeon (OR 5.62 [1.68, 18.77]) were associated with increased odds of postoperative complication. Patient wealth was not associated with odds of postoperative complication.

Conclusions

Barriers to surgery were common in Republic of Congo. Patient wealth and home location may predict barriers to surgery. Addressing gender disparities, access to providers, and patient perception of barriers in addition to removal of barriers may help maximize patient health benefits.

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References

  1. Meara JG, Leather AJ, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624

    Article  PubMed  Google Scholar 

  2. Shrime MG, Dare AJ, Alkire BC et al (2015) Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Glob Health 3(Suppl 2):S38–S44

    Article  PubMed  PubMed Central  Google Scholar 

  3. Alkire BC, Raykar NP, Shrime MG et al (2015) Global access to surgical care: a modelling study. Lancet Glob Health 3:e316–e323

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ozgediz D (2008) Riviello R The, “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5:e121

    Article  PubMed  PubMed Central  Google Scholar 

  5. Debas HT GR, McCord C et al (2012) Surgery promoting essential surgery in low-income countries; a hidden costeffective treasure. In: Jamison DT BJ, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn, New York, The International Bank for Reconstruction and Development/The World Bank Group, pp 1245–1260

  6. Grimes CE, Law RS, Borgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36:8–23. doi:10.1007/s00268-011-1330-1

    Article  PubMed  Google Scholar 

  7. Kikwilu EN, Frencken JE, Mulder J et al (2009) Barriers to restorative care as perceived by dental patients attending government hospitals in Tanzania. Community Dent Oral Epidemiol 37:35–44

    Article  CAS  PubMed  Google Scholar 

  8. Ozgediz D, Kijjambu S, Galukande M et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371:627–628

    Article  PubMed  Google Scholar 

  9. Choo S, Perry H, Hesse AA et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool Tropical medicine & international health. TMIH 15:1109–1115

    Google Scholar 

  10. Iddriss A, Shivute N, Bickler S et al (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89:565–572

    Article  PubMed  PubMed Central  Google Scholar 

  11. Contini S, Taqdeer A, Cherian M et al (2010) Emergency and essential surgical services in Afghanistan: still a missing challenge. World J Surg 34:473–479. doi:10.1007/s00268-010-0406-7

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  13. 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 145:154–159

    Article  PubMed  Google Scholar 

  14. Henry JA, Bem C, Grimes C et al (2015) Essential surgery: the way forward. World J Surg 39:822–832. doi:10.1007/s00268-014-2937-9

    Article  PubMed  Google Scholar 

  15. Wilkinson RMM (2003) Social determinants of health: the solid facts. WHO Library Cataloguing in Publication Data, 2003, Denmark

  16. Marmot M (2005) Social determinants of health inequalities. Lancet 365:1099–1104

    Article  PubMed  Google Scholar 

  17. Blumenthal D (2014) Collins SR Health care coverage under the Affordable Care Act—a progress report. N Engl J Med 371:275–281

    Article  CAS  PubMed  Google Scholar 

  18. James CD, Hanson K, McPake B et al (2006) To retain or remove user fees? Reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy 5:137–153

    Article  PubMed  Google Scholar 

  19. Burnham GM, Pariyo G, Galiwango E et al (2004) Discontinuation of cost sharing in Uganda. Bull World Health Organ 82:187–195

    PubMed  PubMed Central  Google Scholar 

  20. Nabyonga J, Desmet M, Karamagi H et al (2005) Abolition of cost-sharing is pro-poor: evidence from Uganda. Health Policy Plan 20:100–108

    Article  CAS  PubMed  Google Scholar 

  21. Xu K, Evans DB, Kadama P et al (2006) Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med 62:866–876

    Article  PubMed  Google Scholar 

  22. Mwabu G, Mwanzia J (1995) Liambila W User charges in government health facilities in Kenya: effect on attendance and revenue. Health Policy Plan 10:164–170

    Article  CAS  PubMed  Google Scholar 

  23. Yates R (2009) Universal health care and the removal of user fees. Lancet 373:2078–2081

    Article  PubMed  Google Scholar 

  24. IDA TWBI Physicians (per 1,000 people), The World Bank Group, 2010–2014

  25. IDA TWBI Republic of Congo, The World Bank Group, 2014

  26. Holmer H, Lantz A, Kunjumen T et al (2015) Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 3(Suppl 2):S9–S11

    Article  PubMed  Google Scholar 

  27. Cheng LH, McColl L, Parker G (2012) Thyroid surgery in the UK and on board the Mercy Ships. Br J Oral Maxillofac Surg 50:592–596

    Article  PubMed  Google Scholar 

  28. The DHS Program DaHS Congo Democratic Republic: Standard DHS, 2013-2014, Rockville, MA US, ICF International, 2013–2014

  29. IDA TWBI Urban population (% of total), The World Bank Group, 2010–2013

  30. IDA TWBI Employment to population ratio, 15 + , total (%) (modeled ILO estimate), The World Bank Group, 2010–2014

  31. Ariyan S, Martin J, Lal A et al (2015) Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the american association of plastic surgeons. Plastic Reconstr Surg 135:1723–1739

    Article  CAS  Google Scholar 

  32. Karthikesalingam A, Markar SR, Holt PJ et al (2010) Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg 97:4–11

    Article  CAS  PubMed  Google Scholar 

  33. Lari AR, Alaghehbandan R (2000) Nosocomial infections in an Iranian burn care center Burns. J Int Soc Burn Inj 26:737–740

    Article  CAS  Google Scholar 

  34. Baicker K, Taubman SL, Allen HL et al (2013) The Oregon experiment–effects of Medicaid on clinical outcomes. N Engl Med 368:1713–1722

    Article  CAS  Google Scholar 

  35. Shrime MGVS, Desalegn D, Johansson KA, Jamison D, Kruk ME (2015) Task sharing or public finance for expanding surgical access in rural Ethiopia: an extended cost-effectiveness analysis. In: Jamison DTGH, Horton S, Jha P et al (eds) Disease control priorities in developing nations, 3rd edn. The World Bank Group, Seattle

    Google Scholar 

  36. Gallegos AM, Wolff KB, Streltzov NA et al. (2015) Gender differences in service utilization among OEF/OIF Veterans with posttraumatic stress disorder after a brief cognitive-behavioral intervention to increase treatment engagement: a mixed methods study women’s health issues: official publication of the Jacobs Institute of Women’s Health 2015

  37. Olszewski AJ, Shrestha R, Cook NM (2015) Race-specific features and outcomes of nodular lymphocyte-predominant Hodgkin lymphoma: Analysis of the National Cancer Data Base. Cancer 121:3472–3480

    Article  PubMed  Google Scholar 

  38. Zhou X, Xue H, Duan R et al (2015) The cross-sectional association of energy intake and dietary energy density with body composition of children in Southwest China. Nutrients 7:5396–5412

    Article  PubMed  PubMed Central  Google Scholar 

  39. Allen SM (1994) Gender differences in spousal caregiving and unmet need for care. J Gerontol 49:S187–S195

    Article  CAS  PubMed  Google Scholar 

  40. Matheson FI, Smith KL, Fazli GS et al (2014) Physical health and gender as risk factors for usage of services for mental illness. J Epidemiol Community Health 68:971–978

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sieber FE, Barnett SR (2011) Preventing postoperative complications in the elderly. Anesthesiol Clin 29:83–97

    Article  PubMed  PubMed Central  Google Scholar 

  42. McLaren ZM, Ardington C (2014) Leibbrandt M Distance decay and persistent health care disparities in South Africa. BMC Health Serv Res 14:541

    Article  PubMed  PubMed Central  Google Scholar 

  43. Stock R (1983) Distance and the utilization of health facilities in rural Nigeria. Soc Sci Med 17:563–570

    Article  CAS  PubMed  Google Scholar 

  44. 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 18:293–311

    Article  Google Scholar 

  45. Nemet GF, Bailey AJ (2000) Distance and health care utilization among the rural elderly. Soc Sci Med 50:1197–1208

    Article  CAS  PubMed  Google Scholar 

  46. Okwaraji YB, Cousens S, Berhane Y et al (2012) Effect of geographical access to health facilities on child mortality in rural Ethiopia: a community based cross sectional study. PloS One 7:e33564

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Echouffo-Tcheugui JB, Dzudie A, Epacka ME et al (2012) Prevalence and determinants of undiagnosed diabetes in an urban sub-Saharan African population. Prim Care Diabetes 6:229–234

    Article  PubMed  Google Scholar 

  48. Dore GJ, Ward J, Thursz M (2014) Hepatitis C disease burden and strategies to manage the burden (Guest Editors Mark Thursz, Gregory Dore and John Ward). J Viral Hepat 21(Suppl 1):1–4

    Article  PubMed  Google Scholar 

  49. The Gap Report (2014) No one left behind. Joint United Nations Programme on HIV/AIDS, Geneva

    Google Scholar 

  50. Organization WH World Health Organization (2011) Global status report on noncommunicable diseases. World Health Organization, Geneva

    Google Scholar 

  51. Ogunmola OJ, Oladosu YO, Olamoyegun MA (2014) Relationship between socioeconomic status and HIV infection in a rural tertiary health center. HIV AIDS (Auckl) 6:61–67

    Google Scholar 

  52. Centre National de la Statistique et des Etudes Economiques (CNSEE) Repartition de la population par Departements et Communes en 1984 et projetee de 2000 a 2015. In: Économiques LDGdCNdlSedÉ editor, Congo, 1984, 1996;Résultats obtenus à partir du RGPH-84 (date de référence le 01/01/85) et la cartographie du RGPH-96 (date de référence 15/06/96)

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Authors’ contributions

B.M.L. and M.G.S. conceived and designed the study. M.G.S., M.W., A.G., G.P.W., D.L.T., G.P., and K.R. acquired the data. B.M.L., M.G.S., B.C.A., M.L.C., and G.P. were involved in the analysis and interpretation of the data. B.M.L. and M.G.S. drafted the manuscript. All authors critically reviewed and revised the manuscript for important intellectual content, contributed to the writing, and are in agreement with its submission.

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Authors and Affiliations

  1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA

    Brian M. Lin, Blake C. Alkire, Mack L. Cheney & Mark G. Shrime

  2. Mercy Ships, Tyler, TX, 75704, USA

    Michelle White, Ana Glover, Greta Peterson Wamah, Davi L. Trotti, Kirstie Randall, Gary Parker & Mark G. Shrime

  3. Mercy Ships, Toamasina, Madagascar

    Michelle White, Ana Glover, Greta Peterson Wamah, Davi L. Trotti, Kirstie Randall, Gary Parker & Mark G. Shrime

  4. Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA

    Mark G. Shrime

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  1. Brian M. Lin
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  2. Michelle White
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Correspondence to Brian M. Lin.

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Lin, B.M., White, M., Glover, A. et al. Barriers to Surgical Care and Health Outcomes: A Prospective Study on the Relation Between Wealth, Sex, and Postoperative Complications in the Republic of Congo. World J Surg 41, 14–23 (2017). https://doi.org/10.1007/s00268-016-3676-x

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  • DOI: https://doi.org/10.1007/s00268-016-3676-x

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