Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland
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Published on: December 20, 2024
Emily R Smith1,2, Tessa L Concepcion3, Mark Shrime4,5
1Duke Global Health Institute, Duke University, Durham, NC, USA. Emily_r_smith@baylor.edu.
Insights
Children in Somaliland face significant delays in accessing surgical care for congenital conditions, leading to preventable disabilities. Quantifying this burden using disability-adjusted life years (DALYs) highlights the need for improved surgical services.
Area of Science:
- Global Health
- Pediatric Surgery
- Public Health
Background:
- Delayed surgical care for congenital conditions in low- and middle-income countries (LMICs) increases mortality and disability risks.
- The precise burden of delayed surgical access for pediatric congenital conditions remains largely unquantified.
- This study aimed to quantify the disease burden associated with delayed surgical care for children with congenital conditions in Somaliland.
Purpose of the Study:
- To quantify the burden of disease attributable to delays in surgical care for children with congenital conditions in Somaliland.
- To identify specific congenital conditions and demographic factors associated with the greatest burden of delayed surgical care.
- To establish a metric for evaluating the impact of interventions aimed at reducing delays in surgical care.
Main Methods:
- A retrospective review of medical records for 280 children undergoing surgery for congenital conditions across 15 hospitals in Somaliland over 12 months.
- Definition of delay as the difference between ideal and actual age at surgery.
- Calculation of disability-adjusted life years (DALYs) to quantify the burden of delayed care, analyzed by condition type, travel distance, and demographics.
Main Results:
- Significant delays in surgical care were observed for 280 children, resulting in 2970 attributable delayed DALYs (8.4 avertable DALYs per child).
- Neurosurgical and anorectal conditions presented the highest burden of delayed DALYs.
- More than 50% of families traveled over 2 hours to reach a surgical facility, primarily in Hargeisa.
Conclusions:
- Children with congenital conditions in Somaliland face substantial delays and long travel distances for surgical care.
- Quantifying the burden of delayed surgical care using avertable DALYs provides a valuable metric for assessing the cost-effectiveness of interventions.
- The findings underscore the urgent need for improved access to timely surgical interventions for pediatric congenital conditions in Somaliland.
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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