Oyania Felix, Stephens Caroline Q, Ullrich Sarah, Kotagal Meera, Kisitu Daniel, Bajunirwe Francis, Ozgediz Doruk E, Poenaru Dan
Division of Pediatric Surgery, Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda; Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, California.
Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, California.
J Surg Res. 2025 Jan;305:156-162. doi: 10.1016/j.jss.2024.11.013. Epub 2024 Dec 18.
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.
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.
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.
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.
高收入和低收入国家在肛门直肠畸形（ARM）治疗结果上存在差异，可能是由于低收入国家诊断延迟所致。由寻求、获得和接受治疗的延迟组成的“三个延迟”模型为探讨这些挑战提供了一个框架。我们试图研究前来接受低位ARM手术矫正的儿童术前延迟的频率和性质。
我们进行了一项横断面研究，调查2021年6月至2023年7月期间乌干达西南部低位ARM儿童的治疗延迟情况。延迟诊断定义为出生后>48小时才做出诊断。研究了潜在的相关因素，如照顾者、社区和医疗保健系统因素。统计学显著性设定为P<0.05。
共有80名患者纳入研究。诊断时的中位年龄为29.2天。82%的患者由父母诊断出异常，74%的患者经历了延迟诊断。在寻求治疗的延迟中，23%的照顾者表示对孩子的病情一无所知。在获得治疗的延迟方面，37%的人遇到经济问题，28%的人在健康中心未得到正确诊断，这导致了接受治疗的延迟。
低位ARM儿童经常出现治疗延迟。经济状况、照顾者和医护人员的知识对这些延迟有显著影响。为了减少这些延迟，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初级卫生保健提供者的培训。
