Identifying delays to emergency laparotomy in a low-resource setting using the Three Delays Model: a prospective...

Area of Science:

• Global Health
• Surgical Care Disparities
• Low- and Middle-Income Countries

Background:

• Growing global focus on surgical care disparities in LMICs.
• Application of the Three Delays Model to surgical populations.
• Limited data on emergency abdominal surgery delays in Sub-Saharan Africa.

Purpose of the Study:

• Identify longest delays in accessing emergency laparotomy in Zambia.
• Determine factors associated with these delays.
• Assess the relationship between delays and mortality.

Main Methods:

• Prospective observational study of 240 emergency laparotomy patients in Lusaka, Zambia.
• Data collection via questionnaires and medical records using the Three Delays Model framework.
• Multivariable regression analyses to identify predictors of delay and association with mortality.

Main Results:

• Median total delay to laparotomy was 34 hours, with the longest phase being 'seeking care' (18.5 hours).
• Belief that symptoms would resolve and inter-facility referral predicted longer 'seeking care' delays.
• Factors like less urgent indication and education status predicted longer 'reaching care' delays.

Conclusions:

• The most significant delays in emergency laparotomy access occur prior to health system entry in Zambia.
• Symptom misperception and prior facility referral are key modifiable predictors of delay.
• Addressing pre-system delays is crucial for improving emergency surgical care in the region.