A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study

Abstract

Background: A majority of the 2 billion children lacking access to safe, timely and affordable surgical care reside in low-and middle-income countries. A barrier to tackling this issue is the paucity of information regarding children's journey to surgical care. We aimed to explore children's journeys and its implications on accessing general paediatric surgical care at Muhimbili National Hospital (MNH), a tertiary centre in Tanzania.

Methods: A prospective observational cohort study was undertaken at MNH, recruiting patients undergoing elective and emergency surgeries. Data on socio-demographic, clinical, symptoms onset and 30-days post-operative were collected. Descriptive statistics and Mann-Whitney, Kruskal-Wallis and Fisher's exact tests were used for data analysis.

Result: We recruited 154 children with a median age of 36 months. The majority were referred from regional hospitals due to a lack of paediatric surgery expertise. The time taken to seeking care was significantly greater in those who self-referred (p = 0.0186). Of these participants, 68.4 and 31.1% were able to reach a referring health facility and MNH, respectively, within 2 h of deciding to seek care. Overall insurance coverage was 75.32%. The median out of pocket expenditure for receiving care was $69.00. The incidence of surgical site infection was 10.2%, and only 2 patients died.

Conclusion: Although there have been significant efforts to improve access to safe, timely and affordable surgical care, there is still a need to strengthen children's surgical care system. Investing in regional hospitals may be an effective approach to improve access to children surgical care.

Fig. 1

Zones participants reside in. Central Zone (blue) = 4 participants. Northern Zone (yellow) = 6 participants. Coastal Zone (red) = 111 participants. Southern Zone (pink) = 14 participants. Green Zone (green) = 16 participants. Zanzibar (purple) = 2 participants. Unknown = 1 participant. The black star represents the location of Muhimbili National Hospital

Fig. 2

a Referring health facilities and b the main reasons for referral of children seeking surgical care at MNH

Fig. 3

a Days taken from first symptom of current diagnosis to seeking care b Hours taken from deciding to seek care to reaching a referring health facility c Hours taken from deciding to seek care to reaching MNH among self-referred patients d Hours taken from deciding to seek care to reaching MNH among all patients. The results are segregated based on the participant’s zone of residence. The height of the bars represents the median, and the error bars represent the interquartile range

Fig. 4

The days taken to seek care from first symptom of current diagnosis based on (a) the type of referral, and (b) the age of the caregiver. The height of the bars represents the median, and the error bars represent the interquartile range

Fig. 5

The relationship between mode of transport and (a) the hours taken from deciding to seek care to reaching a referring health facility, and (b) the hours taken to reaching care at MNH among all patients. The height of the bars represents the median, and the error bars represent the interquartile range. (c) Heat map of the hours taken from deciding to seek care to reaching MNH among all patients taken. MNH: Muhmbili National Hospital. (d) Heat map of the hours taken from deciding to seek care to reaching a referring health facility