title: Gender differences in the utilisation of surgery for congenital heart disease in India.
abstract: BACKGROUND
  Corrective surgery for congenital heart disease may be life-saving, but its utilisation depends upon several social and economic factors. Girls with cardiac defects may not receive equitable care in India, but this has not been systematically studied.
  
  
  METHODS
  In this prospective study, parents or guardians of 405 consecutive children aged up to 12 years (mean ± SD age 3.43 ± 3.44 years; 271 boys) who had been advised to undergo elective paediatric cardiac surgery were interviewed using a validated questionnaire. The status of the patients was reviewed after a year and the factors associated with non-compliance with treatment were analysed. In a qualitative sub-study the parents of 20 children who had not undergone surgery were interviewed. Qualitative data were analysed using an inductive analytical approach.
  
  
  RESULTS
  Of the 405 patients studied, 44% (59/134) of girls had undergone surgery at 1 year compared with 70% (189/271) of boys (χ²=24.97; p<0.001). Independent predictors for non-compliance with surgery included female gender (OR 3.46, 95% CI -2.06 to 5.80; p<0.0001), lower socioeconomic classes (lower-middle: OR 18.62, 95% CI -2.14 to 161.8, p=0.008; upper-lower: OR 34.27, 95% CI -3.72 to 316.0, p=0.002) and higher cost of surgery (OR 1.92, 95% CI -1.06 to 3.47, p=0.03). In the in-depth interviews, apprehensions about future matrimonial prospects of girls and lack of social support emerged as the major factors responsible for delays in undergoing surgery.
  
  
  CONCLUSIONS
  Female gender is an important determinant of non-compliance with paediatric cardiac surgery. Deep-seated social factors underlie this gender bias.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. ramakgmc@rediffmail.com
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Rohan
authors.initials: R
authors.lastname: Khera
authors.forename: Snigdha
authors.initials: S
authors.lastname: Jain
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Suparna
authors.initials: S
authors.lastname: Kailash
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Kothari
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Balram
authors.initials: B
authors.lastname: Bhargava
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.forename: Manju
authors.initials: M
authors.lastname: Mehta
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Bahl
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007194:India; D008297:Male; D011287:Prejudice; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data*