Elsevier

Surgery

Volume 160, Issue 2, August 2016, Pages 501-508
Surgery

Global Medicine
Assessing access to surgical care in Nepal via a cross-sectional, countrywide survey

https://doi.org/10.1016/j.surg.2016.03.012Get rights and content

Background

Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool.

Methods

Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ2 test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy.

Results

Of respondents with a surgical condition (n = 1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P < .001) and median transport costs to secondary and tertiary centers (P < .001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66–1.80, P < .01). Those without transport money were less likely to access care at any facility in all analyses (P < .01).

Conclusion

The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration.

Section snippets

Methods

This study took place in Nepal from May 25 to June 12, 2014. Both the Nepal Health Research Council in Kathmandu, Nepal, and the Nationwide Children's Hospital in Columbus, Ohio, provided Institutional Review Board approval.

Results

The overall demographics of the study population have been reported previously.17 Of the 1,342 respondents who reported a surgical complaint in ≥1 of 6 anatomic regions or a pregnancy during their lifetime, information was available for 887 (66.1%) individuals on whether care at a health facility was sought. Within this group, 650 (73.3%) people accessed care through 1,141 health facility visits across their lifetimes, resulting in a median of 2 (interquartile range [IQR] 1, 2) visits per

Discussion

Providing access to essential surgical care in LMICs could avert 1.5 million deaths annually.1 These data have been calculated based on multiple aggregated studies and resources; however, prior to our work, no formal, community-based assessment addressing access to surgical care in Nepal had been published.

We calculated 17.7% (95% confidence interval [CI]: 15.7–19.8%) of the study population had a surgical ailment in their lifetime for which they lacked access to care. Extrapolating to the

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    The authors declare no conflicts of interest related to this work.

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