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Inequitable Access to Timely Cleft Palate Surgery in Low- and Middle-Income Countries
Lucas C Carlson1,2, Kristin W Hatcher3, Lindsay Tomberg3
1Department of Emergency Medicine, Brigham & Women's Hospital, 75 Francis St., NH-2, Boston, MD, 02115, USA. lccarlson@partners.org.
Insights
Delayed cleft palate repair is linked to lower national income, increasing mortality risks. This study highlights significant global health inequities in surgical access for children in low-income nations.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Economics
Background:
- Delayed cleft palate repair negatively impacts child well-being and survival in low- and middle-income countries (LMICs).
- Access to timely surgical intervention is crucial for mitigating these adverse outcomes.
Purpose of the Study:
- To investigate the correlation between national income (GDP per capita) and delayed access to primary cleft palate surgery in LMICs.
- To quantify the association between economic status and the timeliness of surgical care.
Main Methods:
- A logistic regression analysis was conducted using medical records from Operation Smile programs in 11 LMICs (March-May 2014).
- Delayed surgery access was defined as primary palatoplasty presentation after 24 months of age.
- The relationship between delayed surgery and GDP per capita was assessed.
Main Results:
- A 14% increase in the odds of late surgery was observed for every $1000 USD decrease in GDP per capita (OR = 0.88).
- This association was more pronounced in low- and lower-middle-income countries, with a 70% increase in late surgery odds for every $1000 USD GDP per capita decrease (OR = 0.59).
- Median presentation age varied significantly by income level, with low-income countries showing the widest range.
Conclusions:
- A strong negative correlation exists between national income and timely access to cleft palate surgery, revealing significant global health inequities.
- Urgent attention to equity in surgical care access is needed, particularly for vulnerable populations in LMICs.
- Integrating an equity perspective into global health dialogues is essential for ensuring universal access to essential surgical services.
Background:
Delayed cleft palate repair has significant implications for physical, mental, and social well-being and has been suggested to lead to an increased risk of infant and under-five mortality in low- and middle-income countries (LMICs).
Methods:
Using medical records from Operation Smile international programs taking place in eleven different LMICs between March and May 2014, we performed a logistic regression assessing the relationship between delayed surgery access, defined as primary palatoplasty presentation after 24 months of age, and GDP per capita across 11 countries.
Results:
Median age of presentation ranged from 13 to 24 months in upper-middle-income countries, 17 to 35 months in lower-middle-income countries, and 14 to 66 months in low-income countries. Our analysis demonstrated a 14 % increase in the odds of late surgery [OR = 0.88 (P < 0.001)] for every 1000 USD decrease of GDP per capita. In low- and lower-middle-income countries, this relationship was even stronger, with an OR of 0.59 (P < 0.001), indicating a 70 % increase in the odds of late surgery for every 1000 USD decrease in GDP per capita.
Conclusions:
There is a strong negative correlation between national income status and delayed access to primary cleft palate surgery, indicating a high degree of inequity in access to surgery, particularly in low- and lower-middle-income countries. As the importance of surgery in global health is increasingly recognized, an equity perspective must be included in the global dialog to ensure that the world's poor have fair and equitable access to essential surgical care.
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