Robbins College of Health and Human Sciences, Baylor University, Waco, United States of America.
Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, United States of America.
PLoS One. 2018 Nov 1;13(11):e0205132. doi: 10.1371/journal.pone.0205132. eCollection 2018.
In low and middle-income countries, approximately 85% of children have a surgically treatable condition before the age of 15. Within these countries, the burden of pediatric surgical conditions falls heaviest on those in rural areas. The objective of the current study was to evaluate the relationship between rurality, surgical condition and treatment status among a cohort of Ugandan children.
We identified 2176 children from 2315 households throughout Uganda using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey. Children were randomly selected and were included in the study if they were 18 years of age or younger and had a surgical condition. Location of residence, surgical condition, and treatment status was compared among children.
Of the 305 children identified with surgical conditions, 81.9% lived in rural areas. The most prevalent causes of surgical conditions reported among rural and urban children were masses (24.0% and 25.5%, respectively), followed by wounds due to injury (19.6% and 16.4%, respectively). Among children with untreated surgical conditions, 79.1% reside in rural areas while 20.9% reside in urban areas. Among children with untreated surgical conditions, the leading reason for not seeking surgical care among children living in both rural and urban areas was a lack of money (40.6% and 31.4%, respectively), and the leading reason for not receiving care in both rural and urban settings was a lack of money (48.0% and 42.8%, respectively).
Our data suggest that over half of the children with a surgical condition surveyed are not receiving surgical care and a large majority of children with surgical needs were living in rural areas. Future interventions aimed at increasing surgical access in rural areas in low-income countries are needed.
在中低收入国家，85%的儿童在 15 岁之前存在可通过手术治疗的疾病。在这些国家中，农村地区儿童的儿科手术疾病负担最重。本研究的目的是评估乌干达儿童队列中农村地区、手术条件与治疗状况之间的关系。
我们使用海外外科医生手术需求评估（SOSAS）调查，在乌干达的 2315 户家庭中确定了 2176 名儿童。如果儿童年龄在 18 岁或以下且患有手术疾病，他们会被随机选择并纳入研究。我们比较了居住地点、手术疾病和治疗状况在儿童中的差异。
在所确定的 305 名患有手术疾病的儿童中，81.9%居住在农村地区。农村和城市儿童报告的最常见手术疾病原因是肿块（分别为 24.0%和 25.5%），其次是因受伤引起的伤口（分别为 19.6%和 16.4%）。在未接受手术治疗的手术疾病儿童中，79.1%居住在农村地区，20.9%居住在城市地区。在未接受手术治疗的手术疾病儿童中，农村和城市地区儿童未寻求手术治疗的主要原因都是缺乏资金（分别为 40.6%和 31.4%），而农村和城市地区未接受治疗的主要原因都是缺乏资金（分别为 48.0%和 42.8%）。
我们的数据表明，接受调查的手术疾病儿童中，超过一半未接受手术治疗，而大多数有手术需求的儿童都居住在农村地区。未来需要在低收入国家的农村地区开展增加手术机会的干预措施。
