title: Factors determining access to surgery for children with congenital cardiac disease in Guatemala, Central America.
abstract: BACKGROUND
  Surgical intervention for children with congenital cardiac disease in the developing world often occurs late. Our objective was to identify factors that placed Guatemalan children at risk for delayed care.
  
  
  METHODS
  We investigated the medical and socioeconomic background of 178 children under the age of 18 years who received their first corrective surgery for congenital cardiac disease at the Unidad de Cirugía Cardiovascular de Guatemala in 2002. A retrospective review of medical records was performed. Each case was stratified into one of three surgical classes based upon customary practice in the United States of America. The outcome we measured was age at surgery, adjusting for the surgical class. Logistic regression was performed and odds ratios calculated.
  
  
  RESULTS
  In univariate analyses, patients presented later for surgery if they were from rural areas (p equals 0.001), did not have social security membership (p equals 0.004), or paid any amount towards the cost of their surgery (p less than 0.001). Age at surgery was also positively correlated with the distance of the home of the patient from the surgical centre (p equals 0.002). For the subset of patients who applied for financial assistance, we found that children presented later for surgery if they required institutional support (p equals 0.001), or came from households of larger size (p less than 0.001).
  
  
  CONCLUSIONS
  Guatemalan children with congenital cardiac disease may be at risk for delayed surgical care if they come from rural areas, areas distant from the surgical centre, or from families without membership of social security.
authors.affiliation: Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA. rachel.kowalsky@gmail.com
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Kowalsky
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: William M
authors.initials: WM
authors.lastname: Rand
authors.forename: Aldo R
authors.initials: AR
authors.lastname: Castañeda
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors