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Factors determining access to surgery for children with congenital cardiac disease in Guatemala, Central America

Published online by Cambridge University Press:  14 July 2006

Rachel H. Kowalsky ,
Jane W. Newburger ,
William M. Rand  and
Aldo R. Castañeda
Rachel H. Kowalsky
Affiliation:
Morgan Stanley Children's Hospital of New York Presbyterian, New York, United States of America
Jane W. Newburger
Affiliation:
Department of Cardiology at Children's Hospital Boston and Department of Pediatrics at Harvard Medical School, Boston, Massachusetts, United States of America
William M. Rand
Affiliation:
Tufts University School of Medicine, Boston, Massachusetts, United States of America
Aldo R. Castañeda
Affiliation:
Dirección de Pediatría, La Unidad de Cirugía Cardiovascular de Guatemala, Ciudad de Guatemala, Guatemala Centroamerica
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Abstract

Background: Surgical intervention for children with congenital cardiac disease in the developing world often occurs late. Our objective was to identify factors that placed Guatemalan children at risk for delayed care. Methods: We investigated the medical and socioeconomic background of 178 children under the age of 18 years who received their first corrective surgery for congenital cardiac disease at the Unidad de Cirugía Cardiovascular de Guatemala in 2002. A retrospective review of medical records was performed. Each case was stratified into one of three surgical classes based upon customary practice in the United States of America. The outcome we measured was age at surgery, adjusting for the surgical class. Logistic regression was performed and odds ratios calculated. Results: In univariate analyses, patients presented later for surgery if they were from rural areas (p equals 0.001), did not have social security membership (p equals 0.004), or paid any amount towards the cost of their surgery (p less than 0.001). Age at surgery was also positively correlated with the distance of the home of the patient from the surgical centre (p equals 0.002). For the subset of patients who applied for financial assistance, we found that children presented later for surgery if they required institutional support (p equals 0.001), or came from households of larger size (p less than 0.001). Conclusions: Guatemalan children with congenital cardiac disease may be at risk for delayed surgical care if they come from rural areas, areas distant from the surgical centre, or from families without membership of social security.

Keywords

Latin Americacardiac surgeryhealth disparities
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 4 , August 2006 , pp. 385 - 391
Copyright
© 2006 Cambridge University Press

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