Delayed access to essential surgical care in Uganda: A tertiary multi-center study

Background: Surgery has been largely neglected within global public health despite growing evidence that the overall burden of disease requiring surgical intervention is rapidly growing and affordable access to surgical care can avert many deaths and disabilities. This study assessed the factors influencing delayed access to essential surgical care in Uganda. Methods: A descriptive multi-center cross-sectional survey was carried out in three hospitals designated for major surgeries in Uganda from December 2019 to December 2021 across three regions of the country in a prospective manner. Patients admitted to the hospitals that required surgical intervention were included. Bivariate analysis using the chi-square test or Fischers' exact test and multivariable logistic regression models to adjust for confounders were carried out. Findings: A total of 635 patients participated in the study of which the majority were males (n = 399, 63%) from the Northern region (n = 347, 54.7%.). Most patients and sought surgical help immediately (n = 406, 63.9%) and were operated on time (n = 402, 63.3%), however only 23.3% (n = 148) were able to reach the hospital for care on time. Caretakers' hesitancy on the surgical procedure (aOR: 2.41 95% CI: 1.07 - 5.43; p = 0.035), hospital inaccessibility (aOR: 5.35 95% CI: 1.82 - 5.75; p = 0.002), and delayed surgical procedure performance (aOR: 6.37 95% CI: 2.64 - 5.34; p<0.001) contributed to surgical delays among other factors. Interpretation: All three factors contribute to surgical delay but most significantly access to hospital. Several socioeconomic factors like education, long distances, and poverty interplay in a complex web to hamper access to essential surgical care.