Community Experiences Of Surgery In Peri-urban Cape Town

Community Experiences Of Surgery In Peri-urban Cape Town

Moses Isiagi , Salome Maswime, Bruce Biccard, Lydia Caincross, Simon Le Roux, Tracey Adams, Nowhi Mdayi, Marian Kinnes, Oluchi Mbamalu, Jacob Gizamba, Robin Veitch, Eva Akurut, Lebohang Fadiran, Yanelisa Pulani
Division of Global Surgery, Department Surgery, Groote Schuur Hospital and University of Cape Town, 7925, South Africa, Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, 7925, South Africa, Cape Town, South Africa; Department Surgery, Groote Schuur Hospital and University of Cape Town, 7925, South Africa, Cape Town, South Africa; Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, 7925, South Africa, Cape Town, South Africa; Department Surgery, Groote Schuur Hospital and University of Cape Town, 7925, South Africa,, Cape Town, South Africa; Spatial Sciences Institute, University of South California, Los Angeles, California, USA, Carlifornia, United States; Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda, Kampala, Uganda; Acute Care Unit, Department of Surgery, at the Groote Schuur Hospital and University of Cape Town, 7925, South Africa, Cape Town, South Africa

Introduction
Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings. The aim of the study was to determine the surgical experiences of individuals in a peri-urban community in South Africa.

Methods
A household survey was conducted to understand the surgical experiences of individuals in a peri-urban Cape Town community. The secondary objectives included describing the surgical burden of disease, surgical outcomes, health-seeking behaviour and acceptability of healthcare services in the community.

Results
Data from 432 valid responses out of 450 showed that chronic diseases were common affecting (56% overall), with higher prevalence in females (60% vs 47%) than in males, p<0.05). Most participants (44%) lived within 10km of their nearest healthcare facility, predominantly public facilities (97%). The Three Delays Framework revealed that 20% delayed seeking surgical care, 26% experienced delays reaching facilities, and 32% faced delays in receiving appropriate care, with 22% reporting no delays. The surgical burden was substantial, with 60% having undergone surgery in their lifetime, and 195 surgical procedures were performed in the last five years. Postoperative disability affected 10% of participants, primarily manifesting as body function impairments (51.2%) and activity limitations (16.3%). Only 67% understood post-surgical treatment protocols.
Conclusion
This study reveals significant challenges in surgical care delivery in this peri-urban community. Key findings include high chronic disease burden, substantial delays in accessing surgical care, and significant postoperative disability rates. These results highlight the need for comprehensive interventions targeting chronic disease.

Funding: This research was funded by the NIHR 133850 (NIHR Global Health Group on Perioperative and Critical Care) using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK government.

Keywords: Global surgery, Community Experiences, Surgery, Low resourced setting