M. Munyaneza1,2, S. Jayaraman3, F. Ntirenganya1,2, J. Rickard2,4 1University of Rwanda,College Of Medicine And Health Sciences, Department Of Surgery,Kigali, XX, Rwanda 2University Teaching Hospital of Kigali,Department Of Surgery,Kigali, XX, Rwanda 3Virginia Commonwealth University,Department Of Surgery,Richmond, VA, USA 4University Of Minnesota,Department Of Surgery,Minneapolis, MN, USA
Introduction:
Peritonitis is a common surgical emergency with a high mortality rate. Prompt recognition and surgical treatment is the mainstay of therapy. In Rwanda, patients often present critically ill with delayed presentation. A better understanding of patient care prior to arrival at the referral hospital is needed to identify areas for improvement. The aim of this study was to describe delays in Rwandan patients presenting to a referral hospital with peritonitis.
Methods:
This is a cross-sectional observational study of patients with peritonitis admitted to the department of surgery at a tertiary referral hospital in Rwanda. Data was collected on demographics, clinical course and patient delays. Patient delays were characterized according to the Three Delays Model. Factors related to delays in seeking care included consultation of traditional healers, understanding the need for medical attention, perceptions and acceptance of surgery and the healthcare system. Factors related to delays in reaching care included travel time, cost, and availability. Data entry and analysis was done using Google Form software.
Results:
Over an 8-month time period, 54 patients with peritonitis were admitted to the referral hospital with peritonitis. Most (n=37, 68%) patients were male. For education, 20 (37%) patients had attended only primary school and 15 (28%) never went to school. A large number (48%) were unemployed and most (n=45, 83%) patients used community-based health insurance. For most patients (n=44, 81%) the monthly income was less than 10,000 Rwandan Francs (11 U.S. Dollars). The average duration of symptoms prior to presentation at the referral hospital was 48 hours.
A large number (n=37, 69%) of patients consulted a traditional healer prior to presentation at the healthcare system. Most (n=29, 53%) patients travelled more than 2 hours to reach a health facility. A large number (n=39, 72%) reported prior good experience with health system and believed that surgery could cure abdominal pain.
From the health center to the district hospital, most (n=36, 66%) patients travelled more than 10km. The cost of transportation ranged between 5000-10000 RWF (5-11 U.S. Dollars) for most of them, and 52% of patients arrived at the district hospital between 24 – 48 hours after the onset of abdominal pain. After arrival at the referral hospital, almost all (98%) patients were operated.
Conclusion:
In this study, factors that were influencing seeking and reaching care were associated with sociodemographic characteristics, health-seeking behaviors, the cost of care, and travelling time. These findings may highlight points of interest to conduct a community-based survey, to understand better factors associated with delays in seeking and reaching care for patients with peritonitis.