Community experiences of surgery in peri-urban Cape Town
Isiagi M., Biccard B., Kinney M., Le Roux S., Mdayi N., Kinnes M., Mbamalu O., Gizamba J., Veitch R., Akurut E., Fadiran L., Pulani Y., Maswime S.
Background. Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings. Objective. To determine the surgical experiences of individuals in a peri-urban community in Cape Town, South Africa. Methods. A cross-sectional household survey of individuals in a peri-urban Cape Town community was conducted with door-to door interviews by trained community assistants, who provided multilingual translation of study materials as needed. The study (i) describes the surgical burden of disease and outcomes; (ii) assesses health-seeking behaviour and barriers to care using the Three Delays framework; and (iii) uses descriptive statistics to characterise respondent demographics and surgical experiences and χ2 tests to compare awareness, attitudes and acceptability across genders and locations. Results. Data from 432 valid responses of 450 surveys conducted showed that chronic diseases were common, affecting 240/431 (56%), with a higher prevalence in females than in males (171/285 (60%) v. 63/133 (47%), p<0.05). Most participants (208/432, 44%) lived within 10 km of their nearest healthcare facility, predominantly public facilities (417/432, 97%). The Three Delays framework showed that 87/432 (20%) delayed seeking surgical care, 114/432 (26%) experienced delays reaching facilities and 95/432 (32%) faced delays in receiving appropriate care, while 95/432 (22%) reported no delays. The surgical burden was substantial, with 260/428 (60%) having undergone surgery in their lifetime and 195 surgical procedures performed in the last 5 years. Postoperative disability affected 43/432 (10%) of participants, primarily manifesting as body function impairments (22/43, 51.2%) and activity limitations (7/43, 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 a high chronic disease burden, substantial delays in accessing surgical care and significant postoperative disability rates. These results provide the first comprehensive assessment of surgical experiences in peri-urban Cape Town, highlighting the need for comprehensive interventions targeting chronic disease and surgical care, even in peri-urban areas close to public health facilities.