Barriers in an East African refugee camp: applying the three delays framework to pediatric surgical care
Paul Phan1, Alexander J Blum2, Omar Juma3
1Center for Global Surgery, Department of Surgery, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Insights
Children in a Tanzanian refugee camp face significant delays in surgical care due to multiple barriers. Addressing these delays is critical for improving health outcomes for vulnerable refugee populations.
Area of Science:
- Global Health
- Surgical Care Access
- Refugee Health
Background:
- The three-delays framework identifies barriers in seeking (D1), reaching (D2), and receiving (D3) healthcare.
- Understanding these delays is crucial for improving healthcare access in underserved populations.
Purpose of the Study:
- To apply the three-delays framework to identify factors contributing to delays in surgical care for children in a Tanzanian refugee camp.
- To assess unmet surgical needs and associated barriers within this population.
Main Methods:
- A validated surgical needs survey was administered to parents/guardians of children (0-18 years) in the Nyarugusu refugee camp.
- Multivariate logistic regression analyzed predictors associated with each delay (seeking, reaching, receiving care).
Main Results:
- 48.1% of children with surgically amendable concerns experienced at least one delay.
- Older age, good self-perceived health, and prior primary care use influenced seeking care delays.
- Burns were linked to delays in seeking and reaching care; Congolese nationality and perceived good health predicted delays in receiving care.
Conclusions:
- Children in the refugee camp face substantial, multifactorial delays in accessing surgical care.
- Perceived and unmet surgical needs are significant issues.
- Interventions targeting these delays are essential to improve surgical care outcomes for refugee children.
Purpose:
In global health, the three-delays framework assessses barriers associated with seeking (D1), reaching (D2), and receiving healthcare (D3). This study applies this model to identify factors contributing to delays in surgical care among children living in a Tanzanian refugee camp.
Methods:
A validated surgical needs survey was administered to parents/guardians of children (0-18 years) living in Tanzania's Nyarugusu refugee camp. We quantified the number of children seeking, reaching, and receiving care for surgically amendable concerns according to the three-delays framework. Multivariate logistic regression models identified significantly associated predictors with each delay.
Results:
721 patient with surgically amendable concerns were identified among 513 children, with 247 children (48.1%) experiencing a delay for at least one problem. Characteristics associated with delays in seeking care included older age, self-perception of good health, and not previously using a primary health center. Burns were also associated with delays in seeking and reaching care, while Congolese nationality and self-perceptions of good health were statistically significant predictors for delays in receiving care.
Conclusion:
Children in a Tanzanian refugee camp experience perceived, unmet surgical needs complicated by multifactorial delays to seeking, reaching, and receiving surgical care. Future interventions that reduce delays are crucial for improving outcomes for refugee children.
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