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Patient Barriers to Accessing Surgical Cleft Care in Vietnam: A Multi-site, Cross-Sectional Outcomes Study

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Abstract

Background

Most people who lack adequate access to surgical care reside in low- and lower–middle-income countries. Few studies have analyzed the barriers that determine the ability to access surgical treatment. We seek to determine which barriers prevent access to cleft care in a resource-limited country to potentially enable barrier mitigation and improve surgical program design.

Methods

A cross-sectional, multi-site study of families accessing care for cleft lip and palate deformities was performed in Vietnam. A survey instrument containing validated demographic, healthcare service accessibility, and medical/surgical components was administered. The main patient outcome of interest was receipt of initial surgical treatment prior to 18 months of age.

Results

Among 453 subjects enrolled in the study, 216 (48%) accessed surgical care prior to 18 months of age. In adjusted regression models, education status of the patient’s father (OR 1.64; 95% CI 1.1–2.5) and male sex (OR 1.61; 95% CI 1.1–2.4) were both associated with timely access to care. Distance and associated cost of travel, to either the nearest district hospital or to the cleft surgical mission site, were not associated with timing of access. In a sensitivity analysis considering care received prior to 24 months of age, cost to attend the surgical mission was additionally associated with timely access to care.

Conclusions

Half of the Vietnamese children in our cohort were not able to access timely surgical cleft care. Barriers to accessing care appear to be socioeconomic as much as geographical or financial. This has implications for policies aimed at reaching vulnerable patients earlier.

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Acknowledgements

This study was supported by Operation Smile. JWS and CAY are supported by the Sue Tsao Fellowship in Global Surgery. We are grateful for the assistance of the Vietnam study coordinator team, led by Anh Bui and Hung Ngoc Nguyen.

Author information

Author notes

    Authors and Affiliations

    1. Division of Plastic and Reconstructive Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA

      Jordan W. Swanson, Caroline A. Yao, Allyn Auslander & William P. Magee III

    2. Shriner’s Hospital for Children, Los Angeles, CA, USA

      Jordan W. Swanson & William P. Magee III

    3. Division of Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

      Jordan W. Swanson, Caroline A. Yao & William P. Magee III

    4. Institute of Global Health, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

      Heather Wipfli

    5. Operation Smile Vietnam, Hanoi, Vietnam

      Thi-Hai-Duc Nguyen

    6. Division of Research and Outcomes, Operation Smile International, Virginia Beach, VA, USA

      Kristin Hatcher & Richard Vanderburg

    7. McGregor Comprehensive Cleft Center, Operacion Sonrisa Nicaragua, Colonia Bolonia, Managua, Nicaragua

      Jordan W. Swanson

    Authors
    1. Jordan W. Swanson
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    2. Caroline A. Yao
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    5. Thi-Hai-Duc Nguyen
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    Correspondence to Jordan W. Swanson.

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    We declare no competing interests, real or potential.

    Additional information

    Jordan W. Swanson and Caroline A. Yao have contributed equally to this work.

    This study has 8 authors. The international, multi-site nature of this study involved surgeons, statisticians, and global health researchers from several sites in all key phases of the study. Each meets WJS criteria as an author.

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    Swanson, J.W., Yao, C.A., Auslander, A. et al. Patient Barriers to Accessing Surgical Cleft Care in Vietnam: A Multi-site, Cross-Sectional Outcomes Study. World J Surg 41, 1435–1446 (2017). https://doi.org/10.1007/s00268-017-3896-8

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    • DOI: https://doi.org/10.1007/s00268-017-3896-8

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