Oyania Felix, Eze Anthony N, Ullrich Sarah, Kotagal Meera, Ozgediz Doruk
Surgery, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda.
Duke University Medical Center, Durham, North Carolina, USA.
World J Pediatr Surg. 2024 Dec 24;7(4):e000877. doi: 10.1136/wjps-2024-000877. eCollection 2024.
In Uganda, only two public hospitals provide pediatric surgery services. With less than 10 pediatric surgeons serving approximately 20 million children in Uganda, most patients with anorectal malformations (ARMs) must make several trips to the hospital before undergoing surgery. As a result, households borrow money, sell assets, or solicit contributions from friends and relatives to meet healthcare expenses. We used a cross-sectional study to examine methods families use to raise funds for the treatment of ARMs at a single institution in Southwestern Uganda.
This cross-sectional study was conducted in the pediatric surgery unit at a Regional Referral Hospital/University Teaching Hospital in Southwestern Uganda from June 2021 to July 2023. Participants included caretakers of children presenting with ARMs for treatment at our referral hospital.
A total of 157 participants were enrolled. Mothers were the main caregivers (77.9%) present at the hospital. Out of a median monthly household income of UGX200 000 (US$51.68), families spent a median of UGX50 000 (US$12.92) to travel to the hospital. To raise funds for healthcare expenses, 68% of households reported selling assets.
Families sell household assets to afford ARMs treatment in Southwestern Uganda. Financial protection by the government through a national child health insurance policy would shield families from substantial health-related expenditures and decrease this burden. In addition, targeted policy to strengthen pediatric surgical capacity through workforce expansion and skills training such as the Pediatric Emergency Surgery Course, may minimize costs, improve timeliness of care, and prevent case cancellations.
在乌干达，只有两家公立医院提供儿科手术服务。乌干达有不到10名儿科外科医生为大约2000万儿童服务，大多数肛门直肠畸形（ARM）患者在接受手术前必须多次前往医院。因此，家庭会借钱、出售资产或向亲朋好友募捐以支付医疗费用。我们采用横断面研究来调查乌干达西南部一家机构中家庭为治疗ARM筹集资金的方式。
这项横断面研究于2021年6月至2023年7月在乌干达西南部一家区域转诊医院/大学教学医院的儿科手术科室进行。参与者包括在我们转诊医院接受ARM治疗的儿童的看护人。
共招募了157名参与者。母亲是在医院的主要看护人（77.9%）。家庭月收入中位数为200,000乌干达先令（51.68美元），家庭前往医院的花费中位数为50,000乌干达先令（12.92美元）。为筹集医疗费用，68%的家庭报告出售了资产。
在乌干达西南部，家庭通过出售家庭资产来支付ARM治疗费用。政府通过国家儿童健康保险政策提供的经济保护将使家庭免受与健康相关的巨额支出影响，并减轻这一负担。此外，通过扩大劳动力和开展技能培训（如儿科急诊手术课程）来加强儿科手术能力的针对性政策，可能会降低成本并提高护理及时性，防止手术取消。
