Disparities in Access to Surgical Care within a Lower Income Country: An Alarming Inequity
- 485 Downloads
Surgical care is not uniformly available worldwide. Inequities in surgical care and access may also vary within countries, and the present study aimed to explore these disparities in Pakistan.
The National Health Survey of Pakistan was analyzed. The proportion of people with a history of abdominal surgery (AS) was calculated and associated factors were determined by weighted multivariate logistic regression. Factors tested were age, gender, urban/rural residence, province, literacy, community development index (CDI), and economic status (ES). The CDI was developed for each sampling unit from select household and individual data. The ES was constructed from ownership of assets.
A total of 59 million adults were represented. Abdominal surgery had been performed in 3.2 % adults (95 % confidence interval [CI] = 2.67, 3.84), which corresponded to an annual rate of 85.9 abdominal surgeries per 100,000 population. Wide disparities were noted, with annual rates of AS varying from 37.8 to 215.6 per 100,000 population. Urban residents were independently twice as likely as rural populations to have had AS (95 % CI = 1.3, 2.8). Higher age (OR = 2.6; 95 % CI = 1.7, 4.0), female gender (OR = 1.5; 95 % CI = 1.1, 2.1), and higher ES (OR = 1.9; 95 % CI = 1.2, 2.9) were also independently associated with AS. In rural populations ES was the only factor associated with surgery, whereas in urban populations gender and CDI had important roles to play.
Access to surgical care is disparate and grossly inadequate in Pakistan. This likely contributes to significant preventable morbidity and death. Physical access to surgical facilities, especially in rural areas and for those with a low CDI, is an important concern and should be prioritized in any forthcoming national policies.
KeywordsRural Area Club Foot Surgical Care National Health Survey Perforated Appendix
Conflicts of interest
- 1.Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Dean JGB, Jamison T, Measham AR (eds) Disease control priorities in developing countries. Oxford University Press, New York, pp 1245–1259Google Scholar
- 14.National Institute of Population Studies (NIPS) (2008) Pakistan demographic health survey, 2006–2007. National Institute of Population Studies (NIPS) [Pakistan], Macro International Inc, IslamabadGoogle Scholar
- 15.Pakistan Medical Research Council (1998) National health survey of Pakistan. Health profile of the people of Pakistan 1990–1994. Service NP, IslamabadGoogle Scholar
- 29.Yamasaki-Nakagawa M, Ozasa K, Yamada N et al (2001) Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuber Lung Dis 5:24–31Google Scholar
- 31.Akram M, Khan FJ (2007) Health care services and government spending in Pakistan. In: PIDE working papers, Pakistan Institute of Developmental Econonics, IslamabadGoogle Scholar
- 32.Federal Bureau of Statisitics Government of Pakistan Health Statistics (2011) Social statistics. http://www.statpak.gov.pk/depts/fbs/statistics/social_statistics/social_statistics.html. Accessed 20 Jan 2011