{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:03:45Z","timestamp":1787321025763,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006317","name":"Association for Academic Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Pediatric colorectal conditions cause significant morbidity and financial strain in low\u2010 and middle\u2010income countries, but little is known regarding catastrophic health expenditure (CHE) for pediatric surgical management in sub\u2010Saharan Africa. We examined the familial financial impact of travel expenses for pediatric colorectal disease in Uganda.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n Patients with ostomies who are awaiting elective surgery in southwestern Uganda were enrolled. Caregivers completed surveys on income, assets, and travel expenses. Group comparisons were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n One\u2010hundred ten patients consisting of 78 males (71%) and 32 females (29%) were enrolled. Most had anorectal malformations (\n n<\/jats:italic>\n \u00a0=\u00a059, 54%) followed by Hirschsprung's disease (\n n<\/jats:italic>\n \u00a0=\u00a022, 20%) and were otherwise healthy (\n n<\/jats:italic>\n \u00a0=\u00a096, 87%). Caregivers were mostly young mothers (\n n<\/jats:italic>\n \u00a0=\u00a086, 78%) of median age 29\u00a0years, who worked as farmers (\n n<\/jats:italic>\n \u00a0=\u00a069, 63%), and 65% (\n n<\/jats:italic>\n \u00a0=\u00a072) had less than a secondary education. Median monthly household income was 300,000 UGX ($78). Families took a median of four trips to the hospital, traveled a median one\u2010way distance of 200\u00a0km, and spent a median of 79,000 UGX ($20) on transportation. Based on transportation costs alone, 28% (\n n<\/jats:italic>\n \u00a0=\u00a030) of households experienced CHE. All families were uninsured; most relied on savings (\n n<\/jats:italic>\n \u00a0=\u00a079, 72%) or financial support from nongovernmental organizations (\n n<\/jats:italic>\n \u00a0=\u00a031, 28%). Risk of CHE increased as monthly income decreased (\n p<\/jats:italic>\n \u00a0<\u00a00.001). Lower income households (<\u00a0150K UGX; <\u00a038) were at particular risk of CHE, with 73% (\n n<\/jats:italic>\n \u00a0=\u00a014) spending more than 10% of their income on transportation expenses.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n At least 28% of colorectal patients in our study experienced CHE from transportation costs alone. Much of this transportation was repeated trips to the hospital in unsuccessful attempts to obtain surgical care. Accounting for other out\u2010of\u2010pocket expenses and additional surgeries not included outside of the study period, it is likely that the rate of CHE is higher. In the future, a care coordination program to minimize wasted travel may reduce CHE.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/wjs.70100","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:45:37Z","timestamp":1761183937000},"page":"3431-3440","source":"Crossref","is-referenced-by-count":1,"title":["Financial Impact of Transportation Costs for Ugandan Pediatric Colorectal Patients"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-4515","authenticated-orcid":false,"given":"Anthony N.","family":"Eze","sequence":"first","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina USA"},{"name":"Duke Global Health Pathway Program Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Jane","family":"Commander","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crispus","family":"Bingana","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"McGinnis","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Barter","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara N.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina USA"},{"name":"Duke Global Health Institute Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Oyania","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology Mbarara 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