Felix Oyania, Caroline Q Stephens, Sarah Ullrich, Meera Kotagal, Daniel Kisitu, Francis Bajunirwe, Doruk E Ozgediz, Dan Poenaru
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引用次数: 0
摘要
导言:高收入国家和低收入国家在肛门直肠畸形(ARM)治疗效果上的差异可能是由于后者的诊断延误所致。由寻求、获得和接受治疗过程中的延误组成的 "三延误 "模型为探讨这些挑战提供了一个框架。我们试图研究接受低位 ARM 手术矫正的儿童术前延误的频率和性质:我们开展了一项横断面研究,考察了 2021 年 6 月至 2023 年 7 月间乌干达西南部低位 ARM 儿童的护理延误情况。延迟诊断的定义是诊断时间大于 48 小时。研究了潜在的相关因素,如护理人员、社区和医疗保健系统方面的因素。统计显著性设定为 P 结果:本研究共纳入 80 名患者。82%的患者是由父母诊断出异常的,74%的患者被延迟诊断。在延误就诊的患者中,23%的护理人员表示不了解孩子的疾病。在就医延误方面,37%的患者遇到了经济问题,28%的患者没有得到医疗中心的适当诊断,这些都是导致就医延误的原因:结论:ARM 偏低的儿童经常会延误治疗。结论:ARM 偏低的儿童经常出现就医延迟的情况,资金问题以及护理人员和医护人员的知识水平在很大程度上导致了就医延迟。为了减少这些延误,我们建议改进转诊流程,优先进行新生儿筛查,倡导国家儿童健康保险政策,并加强对初级医疗保健提供者的培训。
Delays in Care for Children With Low Anorectal Malformations in Southwestern Uganda.
Introduction: Disparities in anorectal malformation (ARM) outcomes between high- and low-income countries may be due to delayed diagnosis in the latter setting. The Three Delays model, comprising delays in seeking, accessing, and receiving care, provides a framework for exploring these challenges. We sought to examine the frequency and nature of the preoperative delays in children presenting for surgical correction of low ARMs.
Methods: We conducted a cross-sectional study examining the delays in care among children with low ARMs in Southwestern Uganda between June 2021 and July 2023. Delayed diagnosis was defined as a diagnosis made >48 h of life. Potential associated factors such as caregiver, community, and aspect of health-care system factors were examined. Statistical significance was set at P < 0.05.
Results: A total of 80 patients were included in the study. The median age at diagnosis was 29.2 d. In 82% of patients, the parents diagnosed the abnormality and 74% experienced delayed diagnosis. Among delays in seeking care, 23% of caregivers reported no knowledge of their child's disease. For delays in reaching care, 37% encountered financial problems, and 28% lacked an appropriate diagnosis from a health center, contributing to delays in receiving care.
Conclusions: Delays in care are frequent for children with low ARMs. Finances and caregivers' and health-care workers' knowledge contribute significantly to these delays. To mitigate these delays, we recommend improving referral processes, prioritizing newborn screening examinations, advocating for a national child health insurance policy, and enhancing the training of primary health-care providers.
期刊介绍:
The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.