Department of Surgery, Stanford University, Stanford, California.
Department of Surgery, Connaught Hospital, Freetown, Sierra Leone3College of Medicine and Allied Health Science, Freetown, Sierra Leone.
JAMA Surg. 2016 Mar;151(3):257-63. doi: 10.1001/jamasurg.2015.3431.
Surgical care is recognized as a growing component of global public health.
To assess self-reported barriers to access of surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool.
DESIGN, SETTING, AND PARTICIPANTS: Data for this cross-sectional, cluster-based population survey were collected from households in Rwanda (October 2011), Sierra Leone (January 2012), and Nepal (May and June 2014) using the Surgeons OverSeas Assessment of Surgical Need tool.
Basic demographic information, cost and mode of transportation to health care facilities, and barriers to access to surgical care of persons dying within the past year were analyzed.
A total of 4822 households were surveyed in Nepal, Rwanda, and Sierra Leone. Primary health care facilities were commonly reached rapidly by foot (>70%), transportation to secondary facilities differed by country, and public transportation was ubiquitously required for access to a tertiary care facility (46%-82% of respondents). Reasons for not seeking surgical care when needed included no money for health care (Sierra Leone: n = 103; 55%), a person dying before health care could be arranged (all countries: 32%-43%), no health care facility available (Nepal: n = 11; 42%), and a lack of trust in health care (Rwanda: n = 6; 26%).
Self-reported determinants of access to surgical care vary widely among Sierra Leone, Rwanda, and Nepal, although commonalities exist. Understanding the epidemiology of barriers to surgical care is essential to effectively provide surgical service as a public health commodity in developing countries.
外科护理被认为是全球公共卫生日益重要的组成部分。
使用经过验证的海外外科医生手术需求评估工具，评估塞拉利昂、卢旺达和尼泊尔获取外科护理的自我报告障碍。
设计、地点和参与者：本横断面、基于聚类的人群调查数据来自卢旺达（2011 年 10 月）、塞拉利昂（2012 年 1 月）和尼泊尔（2014 年 5 月和 6 月）的家庭，使用海外外科医生手术需求评估工具。
分析了过去一年中死亡的人的基本人口统计学信息、医疗保健设施的费用和交通方式以及获取外科护理的障碍。
在尼泊尔、卢旺达和塞拉利昂共调查了 4822 户家庭。初级保健设施通常可快速步行到达（>70%），到二级设施的交通方式因国家而异，而获得三级保健设施则普遍需要公共交通工具（46%-82%的受访者）。当需要时不寻求外科护理的原因包括无钱支付医疗保健费用（塞拉利昂：n=103；55%）、在安排医疗保健之前有人死亡（所有国家：32%-43%）、无医疗保健设施可用（尼泊尔：n=11；42%）和对医疗保健缺乏信任（卢旺达：n=6；26%）。
塞拉利昂、卢旺达和尼泊尔获取外科护理的自我报告决定因素差异很大，但也存在共同之处。了解外科护理障碍的流行病学对于在发展中国家有效提供作为公共卫生商品的外科服务至关重要。
