Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework
Tessa L Concepcion1, Shukri Dahir2, Mubarak Mohamed2
1Duke Global Health Institute, Duke University, Durham, NC, USA.
Insights
Children in Somaliland face significant delays in surgical care due to barriers in seeking, reaching, and receiving treatment. Addressing these delays is crucial for improving pediatric surgical outcomes and quality of care.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Services Research
Background:
- Complex barriers impede timely surgical care for children in low- and middle-income countries.
- Understanding these barriers is vital for developing targeted interventions to improve pediatric surgical services.
- The three-delay model (D1: seeking, D2: reaching, D3: receiving care) is a framework for analyzing healthcare access.
Purpose of the Study:
- To evaluate the reasons for delays in surgical care for children in Somaliland.
- To apply the three-delay framework to identify specific barriers in pediatric surgical access.
- To inform policy and interventions for improving surgical care delivery to children.
Main Methods:
- A cross-sectional household survey was conducted with 1503 children in Somaliland.
- Surgical needs were identified, and delays in seeking (D1), reaching (D2), and receiving (D3) care were quantified.
- Multivariate logistic regression analyzed predictors of delays, including child's age, gender, income, and household size.
Main Results:
- Of 196 children with surgical needs, 27.3% experienced delays in seeking care (D1), 20.6% in reaching care (D2), and 71.2% in receiving care (D3).
- Primary reasons for D1 included seeking traditional providers; D2 delays were linked to lack of money and care availability.
- Household size predicted D1 and D3 delays, while condition type and region predicted D2 delays.
Conclusions:
- Children in Somaliland encounter substantial barriers across the entire surgical care continuum.
- The three-delay framework effectively highlights challenges in pediatric surgical care access.
- Tailored interventions based on local context are necessary to reduce delays and enhance the quality of pediatric surgical care.
Background:
There are complex barriers that increase delays to surgical care in low- and middle-income countries, particularly among the vulnerable population of children. Understanding these barriers to surgical care can result in targeted and strategic intervention efforts to improve care for children. The three-delay model is a widely used framework in global health for evaluating barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). The goal of our study is to evaluate reasons for delays in the surgical care for children in Somaliland using the three-delay framework.
Methods:
Data were collected in a cross-sectional study in Somaliland from 1503 children through a household survey. Among children with a surgical need, we quantified the number of children seeking, reaching, and receiving care along the surgical care continuum, according to the three-delay framework. We evaluated predictors of the three delays through a multivariate logistic regression model, including the child's age, gender, village type, household income level, region, and household size.
Results:
Of the 196 children identified with a surgical condition, 50 (27.3%) children had a delay in seeking care (D1), 28 (20.6%) children had a delay in reaching care (D2), and 84 (71.2%) children had a delay in receiving care (D3), including 10 children who also experienced D1 and D2. The main reasons cited for D1 included seeking a traditional healthcare provider, while lack of money and availability of care were main reasons cited for D2. Significant predictors for delays included household size for D1 and D3 and condition type and region for D2.
Conclusion:
Children in Somaliland experience several barriers to surgical care along the entire continuum of care, allowing for policy guidance tailored to specific local challenges and resources. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions, viewing delays in surgical care under the lens of the three-delay framework can inform strategic interventions along the pediatric surgical care continuum, thereby reducing delays and improving the quality of surgical care for children.
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