Evidence map›Paper›PMID 34107950›Full record

ArticleBMC health services research2021

The societal cost and economic impact of surgical care on patients' households in rural Uganda; a mixed method study.

Obieze Nwanna-Nzewunwa, Rasheedat Oke, Esther Agwang, Mary-Margaret Ajiko, Christopher Yoon, Melissa Carvalho, Fred Kirya, Elliot Marseille, Rochelle A Dicker

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Pooled it
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  3. Article
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  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 2 countries.

Obieze Nwanna-NzewunwaDepartment of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
Rasheedat OkeProgram for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Esther AgwangDepartment of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Mary-Margaret AjikoDepartment of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Christopher YoonDavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Melissa CarvalhoProgram for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Fred KiryaDepartment of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Elliot MarseillePrincipal, Health Strategies International, Oakland, California, USA.
Rochelle A DickerProgram for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA. rdicker@mednet.ucla.edu.
University of California, Los Angeles · USSoroti Hospital · UGMaine Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients' households at Soroti Regional Referral Hospital (SRRH), Uganda.

methodsWe prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients' households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined.

resultsWe encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished.

conclusionDespite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.

Indexed as

Family CharacteristicsHealth ExpendituresAdultFemaleHealth ServicesHumansMalePovertyUgandaYoung AdultAfricaCatastrophic medical expenditureEpidemiologyGlobal surgerySocietal costSurgical care costUganda

Identifiers

PMID34107950
PMCPMC8190862
OpenAlexW3170157537

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.