# Barriers in an East African Refugee Camp: Applying the Three Delays Framework to Pediatric Surgical Care

## TL;DR

This study examines why children in a Tanzanian refugee camp face delays in getting surgical care, using a framework that identifies barriers at three stages of care.

## Contribution

The study applies the three-delays framework to pediatric surgical care in a refugee setting, identifying specific factors contributing to delays.

## Key findings

- 48.1% of children experienced at least one delay in surgical care.
- Older age and self-perception of good health were linked to delays in seeking care.
- Burns and Congolese nationality were associated with delays in reaching and receiving care.

## Abstract

In global health, the three-delays framework helps assess barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). This study applies this model to identify factors contributing to delays in surgical care among children living in a Tanzanian refugee camp.

A validated surgical needs survey was administered to parents/guardians of children (0–18 years) living in Tanzania’s Nyarugusu refugee camp. We quantified the number of children seeking, reaching, and receiving care for surgically-amendable concerns according to the three-delays framework. Multivariate logistic regression models identified significantly associated predictors with each delay.

721 patient surgically-amendable concerns were identified among 513 children, with 247 children (48.1%) experiencing a delay for at least one problem. Characteristics associated with delays in seeking care included older age, self-perception of good health, and not previously using a primary health center. Burns were also associated with delays in seeking and reaching care, while Congolese nationality and self-perceptions of good health were statistically significant predictors for delays in receiving care.

Children in a Tanzanian refugee camp experience unmet surgical needs complicated by multifactorial delays to seeking, reaching, and receiving surgical care. Future interventions that reduce delays are essential to improve outcomes for refugee children.