ArticleWorld journal of surgery2020
Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework.
Article in World journal of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review.Pediatric blood & cancer · 2023Pooled it
- Application of the Three Delays Framework to Assess Barriers to Surgical Care in an East African Refugee Camp: A Cross-sectional Survey Among 1,135 Adults.The Journal of surgical research · 2026Article
- Identifying delays to emergency laparotomy in a low-resource setting using the Three Delays Model: a prospective observational study (DEL study).BMJ global health · 2026Observational
- Patient Perceptions and Type 1 Delay in Head and Neck Cancer: A Scoping Review of High- and Low-/Middle-Income Countries.Laryngoscope investigative otolaryngology · 2026Review
- Prevalence and factors associated with delayed surgery among children with Wilms tumor at Mulago Hospital: a mixed-method study.BMC cancer · 2026Article
- Commentary: Pediatric Surgery in Low-Income Countries-From Neglect to Necessity.World journal of surgery · 2025Article
- Barriers in an East African refugee camp: applying the three delays framework to pediatric surgical care.Pediatric surgery international · 2025Article
- Impact of out-of-pocket expenses on children with cancer in Tanzania: A mixed-methods economic study.PloS one · 2025Article
- Epidemiology, outcomes, and access to care for pediatric patients who underwent surgery in Northern Tanzania: A cross-sectional study.PLOS global public health · 2025Article
- Assessment of transfer-time and time-to-surgery as risk factors to survival in Gastroschisis (GS) in a LMIC; an eight-year review.Pediatric surgery international · 2024Article
- GAPS Phase III: incorporation of capacity based weighting in the global assessment for pediatric surgery.Pediatric surgery international · 2024Article
- The Burden of Plastic Surgery in Rural Kenya: The Kapsowar Hospital Experience.Plastic and reconstructive surgery. Global open · 2024Article
- Assessment of anesthesia capacity for children in Somaliland.PLOS global public health · 2024Article
- Modeling the global impact of reducing out-of-pocket costs for children's surgical care.PLOS global public health · 2024Article
- Defining Feasibility as a Criterion for Essential Surgery: A Qualitative Study with Global Children's Surgery Experts.World journal of surgery · 2023Article
- Article
- Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland.World journal of pediatric surgery · 2023Article
- Prevalence and outcomes of pediatric surgical conditions at Connaught Hospital in Freetown: a retrospective study.World journal of pediatric surgery · 2023Article
- Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop.Global health action · 2022Article
- Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study.World journal of surgery · 2022Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere are complex barriers that increase delays to surgical care in low- and middle-income countries, particularly among the vulnerable population of children. Understanding these barriers to surgical care can result in targeted and strategic intervention efforts to improve care for children. The three-delay model is a widely used framework in global health for evaluating barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). The goal of our study is to evaluate reasons for delays in the surgical care for children in Somaliland using the three-delay framework.
methodsData were collected in a cross-sectional study in Somaliland from 1503 children through a household survey. Among children with a surgical need, we quantified the number of children seeking, reaching, and receiving care along the surgical care continuum, according to the three-delay framework. We evaluated predictors of the three delays through a multivariate logistic regression model, including the child's age, gender, village type, household income level, region, and household size.
resultsOf the 196 children identified with a surgical condition, 50 (27.3%) children had a delay in seeking care (D1), 28 (20.6%) children had a delay in reaching care (D2), and 84 (71.2%) children had a delay in receiving care (D3), including 10 children who also experienced D1 and D2. The main reasons cited for D1 included seeking a traditional healthcare provider, while lack of money and availability of care were main reasons cited for D2. Significant predictors for delays included household size for D1 and D3 and condition type and region for D2.
conclusionChildren in Somaliland experience several barriers to surgical care along the entire continuum of care, allowing for policy guidance tailored to specific local challenges and resources. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions, viewing delays in surgical care under the lens of the three-delay framework can inform strategic interventions along the pediatric surgical care continuum, thereby reducing delays and improving the quality of surgical care for children.
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