title: Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique.
abstract: BACKGROUND
  Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique.
  
  
  METHODS
  Data were collected on all inpatients at Hospital Rural de Chókwè in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA.
  
  
  RESULTS
  In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards.
  
  
  CONCLUSIONS
  Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals.
authors.affiliation: The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Faierman
authors.affiliation: University of California, San Diego, Department of Surgery, 200 W. Arbor Drive, San Diego, CA 92103, USA jaa002@ucsd.edu.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: Americo
authors.initials: A
authors.lastname: Assane
authors.affiliation: Dartmouth-Hitchcock Medical Center, Department of Surgery, 1 Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Bendix
authors.affiliation: Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vaz
authors.affiliation: University of California, San Diego, Department of Surgery, 200 W. Arbor Drive, San Diego, CA 92103, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Rose
authors.affiliation: Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: Carlos
authors.initials: C
authors.lastname: Funzamo
authors.affiliation: University of California, San Diego, Department of Surgery, 200 W. Arbor Drive, San Diego, CA 92103, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bickler
authors.affiliation: Universidade Eduardo Mondlane, Maputo, Mozambique University of California, San Diego, Department of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Emilia V
authors.initials: EV
authors.lastname: Noormahomed
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D040841:Resource Allocation; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014195:Travel; D055815:Young Adult
keywords: Access to surgical care; Global surgery; Mozambique; Sub-Saharan Africa