title: Patient Barriers to Accessing Surgical Cleft Care in Vietnam: A Multi-site, Cross-Sectional Outcomes Study.
abstract: Most people who lack adequate access to surgical care reside in low- and lower-middle-income countries. Few studies have analyzed the barriers that determine the ability to access surgical treatment. We seek to determine which barriers prevent access to cleft care in a resource-limited country to potentially enable barrier mitigation and improve surgical program design.
  
  
  
  A cross-sectional, multi-site study of families accessing care for cleft lip and palate deformities was performed in Vietnam. A survey instrument containing validated demographic, healthcare service accessibility, and medical/surgical components was administered. The main patient outcome of interest was receipt of initial surgical treatment prior to 18 months of age.
  
  
  
  Among 453 subjects enrolled in the study, 216 (48%) accessed surgical care prior to 18 months of age. In adjusted regression models, education status of the patient's father (OR 1.64; 95% CI 1.1-2.5) and male sex (OR 1.61; 95% CI 1.1-2.4) were both associated with timely access to care. Distance and associated cost of travel, to either the nearest district hospital or to the cleft surgical mission site, were not associated with timing of access. In a sensitivity analysis considering care received prior to 24 months of age, cost to attend the surgical mission was additionally associated with timely access to care.
  
  
  
  Half of the Vietnamese children in our cohort were not able to access timely surgical cleft care. Barriers to accessing care appear to be socioeconomic as much as geographical or financial. This has implications for policies aimed at reaching vulnerable patients earlier.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. jswans@gmail.com.|Shriner's Hospital for Children, Los Angeles, CA, USA. jswans@gmail.com.|Division of Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. jswans@gmail.com.|McGregor Comprehensive Cleft Center, Operacion Sonrisa Nicaragua, Colonia Bolonia, Managua, Nicaragua. jswans@gmail.com.
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Swanson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.|Division of Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Yao
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Allyn
authors.initials: A
authors.lastname: Auslander
authors.affiliation: Institute of Global Health, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Wipfli
authors.affiliation: Operation Smile Vietnam, Hanoi, Vietnam.
authors.forename: Thi-Hai-Duc
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Division of Research and Outcomes, Operation Smile International, Virginia Beach, VA, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Hatcher
authors.affiliation: Division of Research and Outcomes, Operation Smile International, Virginia Beach, VA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Vanderburg
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.|Shriner's Hospital for Children, Los Angeles, CA, USA.|Division of Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Magee
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006295:Health Resources; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D000071069:Multiple Chronic Conditions; D011795:Surveys and Questionnaires; D014744:Vietnam