Barriers to Surgical Care Access in Rural Burundi: Sociodemographic, Transportation, and Care-Seeking Patterns Associated With Delays in Access to Surgical Care

Abstract

Purpose: Access to timely, safe, and affordable surgical care can improve duration and quality of life and prevent disability; furthermore, the need for sustainable and accessible surgical care is pronounced in low- and middle-income countries (LMIC). Delays in access to surgical care should be identified and addressed, namely delays in deciding to seek medical help, reaching an appropriate facility, and receiving definitive treatment. This study sought to determine patient sociodemographic factors associated with delays in accessing surgical consultation at a district hospital in rural Burundi. Methods: This single-center retrospective cohort study of outpatients presenting to the surgical clinic at Kibuye Hope Hospital used a patient survey to collect demographics and information relating to timeliness and affordability of surgical care. A Cox proportional hazard model was used to determine hazard ratios (HR) with 95 % confidence intervals (95%CI) accessing surgical care across sociodemographic and transportation-related covariates, in order to determine differences in delays seeking care and delays reaching a care facility. Results: In total, 228 patients were enrolled, 36% female, median age 28 years. Factors associated with increased delays in recognizing symptoms as a medical problem included older age (HR:0.99, 95%CI 0.98-0.99) and traditional healer use (HR:0.528, 95%CI:0.31-0.90). Factors associated with increased delays in reaching a care facility included selling livestock to afford care (HR:0.63, 95%CI:0.43-0.94). Orthopedic surgical problems (HR:1.62, 95%CI:1.16-2.26) were associated with decreased delays in recognizing symptoms as a problem and decreased time between problem recognition and care seeking. Factors associated with decreased delays in reaching a care facility included higher levels of education (HR:1.06, 95%CI:1.004-1.11), visiting a health center (HR:1.91, 95%CI:1.18-3.11), a non-surgical hospital (HR:1.86, 95%CI:1.09-3.18), or a surgical hospital (HR:2.06, 95%CI:1.17-3.61). Conclusions: The patient population served by Kibuye Hope Hospital consists mostly of rural subsistence farmers, and most patients have a primary school level of education. Use of traditional healers, older age, lower educational attainment, and selling of livestock were associated with increased delays in accessing surgical care. Surgeons, hospital administrators, and local government officials should be aware of factors associated with delays in accessing care, so that interventions can be targeted at enabling timely delivery of safe and affordable care to vulnerable populations.