title: Barriers to accessing surgical care: a cross-sectional survey conducted at a tertiary care hospital in Karachi, Pakistan.
abstract: BACKGROUND
  The need for surgical care far exceeds available facilities, especially in low income and poor countries. Limited data are available to help us understand the extent and nature of barriers that limit access to surgical care, particularly in the Asian subcontinent. The aim of this study was to understand factors that influence access to surgical care in a low-income urban population.
  
  
  METHODS
  An observational cross-sectional study was conducted on 199 consecutive patients admitted for elective surgery from February to April 2010 to identify the presence and causes of delay in accessing surgical care.
  
  
  RESULTS
  The median duration of symptoms were 7 and 4 months in women and men, respectively. The odds of delay between the onset of symptoms and seeking initial health care (first interval) is twice as likely for women than for men [52.7 vs. 37.5 %, odds ratio (OR) 1.9]. Lack of knowledge regarding treatment options [OR 3.8; 95 % confidence interval (CI) 1.4-10.3] and about disease implications (OR 2.4; 95 % CI 1.2-4.8) were cited most often. A second interval of delay (time from when surgery was first advised to the surgery) was reported by 123 (61.8 %) patients. Financial constraints (29.6 %) and environment-related delays (10.6 %) were cited most often. More women than men thought there was a second delay interval (73 vs. 58 %). The odds of women having more co-morbid conditions were nearly 4.7 times that of men (95 % CI 1.5-15.1).
  
  
  CONCLUSIONS
  A complex interaction of factors limits access to surgical care in developing countries. Women appear to face greater hurdles to accessing health care. Understanding local factors is essential to make care accessible.
authors.affiliation: Indus Hospital Research Center, Indus Hospital, Korangi Crossing, Karachi 75190, Pakistan. lubna.samad@irdresearch.org
authors.forename: Lubna
authors.initials: L
authors.lastname: Samad
authors.forename: Fayez
authors.initials: F
authors.lastname: Jawed
authors.forename: Sana Zehra
authors.initials: SZ
authors.lastname: Sajun
authors.forename: Mohammad Hussham
authors.initials: MH
authors.lastname: Arshad
authors.forename: Naila
authors.initials: N
authors.lastname: Baig-Ansari
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012737:Sex Factors; D062606:Tertiary Care Centers; D014505:Urban Population