title: Barriers to Reconstructive Surgery in Low- and Middle-Income Countries: A Cross-Sectional Study of 453 Cleft Lip and Cleft Palate Patients in Vietnam.
abstract: BACKGROUND
  Despite health system advances, residents of low- and middle-income countries continue to experience substantial barriers in accessing health care, particularly for specialized care such as plastic and reconstructive surgery.
  
  
  METHODS
  A cross-sectional household survey of patients seeking surgical care for cleft lip and/or cleft palate was completed at five Operation Smile International mission sites throughout Vietnam (Hanoi, Nghe An, Hue, Ho Chi Minh City, An Giang, and Bac Lieu) in November of 2014.
  
  
  RESULTS
  Four hundred fifty-three households were surveyed. Cost, mistrust of medical providers, and lack of supplies and trained physicians were cited as the most significant barriers to obtaining surgery from local hospitals. There was no significant difference in household income or hospital access between those who had and had not obtained cleft surgery in the past. Fewer households that had obtained cleft surgery in the past were enrolled in health insurance (p < 0.001). Of those households/patients who had surgery previously, 83 percent had their surgery performed by a charity. Forty-three percent of participants did not have access to any other surgical cleft care and 41 percent did not have any other access to nonsurgical cleft care.
  
  
  CONCLUSIONS
  The authors highlight barriers specific to surgery in low- and middle-income countries that have not been previously addressed. Patients rely on charitable care outside the centralized health care system; as a result, surgical treatment of cleft lip and palate is delayed beyond the standard optimal window compared with more developed countries. Using these data, the authors developed a more evidence-based framework designed to understand health behaviors and perceptions regarding reconstructive surgical care.
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Caroline A
authors: CA
authors: Yao
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Jordan
authors: J
authors: Swanson
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Dayana
authors: D
authors: Chanson
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Trisa B
authors: TB
authors: Taro
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Barrie
authors: B
authors: Gura
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Jane C
authors: JC
authors: Figueiredo
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Heather
authors: H
authors: Wipfli
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Kristin
authors: K
authors: Hatcher
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: Richard
authors: R
authors: Vanderburg
authors: Los Angeles, Calif.; and Virginia Beach, Va.|From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children Hospital Los Angeles; and Operation Smile International.
authors: William P
authors: WP
authors: Magee
mesh_terms: D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000191:economics / Q000601:surgery*; D002972:Cleft Palate / Q000191:economics / Q000601:surgery*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008493:Medical Missions / Q000706:statistics & numerical data; D056948:Orthognathic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014744:Vietnam