title: Barriers to surgical care in Nepal.
abstract: Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care.
  
  
  
  A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care.
  
  
  
  Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54).
  
  
  
  More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.
authors.affiliation: Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium. Joris.vanloenhout@uclouvain.be.
authors.forename: Joris Adriaan Frank
authors.initials: JA
authors.lastname: van Loenhout
authors.affiliation: Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
authors.forename: Tefera Darge
authors.initials: TD
authors.lastname: Delbiso
authors.affiliation: Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Surgical Oncology, Nepal Cancer Hospital, Kathmandu, Nepal.
authors.forename: Kapendra
authors.initials: K
authors.lastname: Amatya
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Surgery, Columbia University, New York, NY, USA.|Surgeons OverSeas, New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
authors.forename: Julita
authors.initials: J
authors.lastname: Gil Cuesta
authors.affiliation: Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
authors.forename: Debarati
authors.initials: D
authors.lastname: Guha-Sapir
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006268:Health Facilities / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008952:Mobile Health Units / Q000706:statistics & numerical data; D009390:Nepal / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D066231:Surgeons / Q000600:supply & distribution*; D000078329:Workforce
keywords: Accessibility; Affordability; Barriers; Fear; Nepal; No trust; Surgical care