{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:32:16Z","timestamp":1792549936840,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,12,15]],"date-time":"2015-12-15T00:00:00Z","timestamp":1450137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,12,15]],"date-time":"2015-12-15T00:00:00Z","timestamp":1450137600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed cleft palate repair has significant implications for physical, mental, and social well\u2010being and has been suggested to lead to an increased risk of infant and under\u2010five mortality in low\u2010 and middle\u2010income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using medical records from Operation Smile international programs taking place in eleven different LMICs between March and May 2014, we performed a logistic regression assessing the relationship between delayed surgery access, defined as primary palatoplasty presentation after 24\u00a0months of age, and GDP per capita across 11 countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age of presentation ranged from 13 to 24\u00a0months in upper\u2010middle\u2010income countries, 17 to 35\u00a0months in lower\u2010middle\u2010income countries, and 14 to 66\u00a0months in low\u2010income countries. Our analysis demonstrated a 14 % increase in the odds of late surgery [OR = 0.88 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001)] for every 1000 USD decrease of GDP per capita. In low\u2010 and lower\u2010middle\u2010income countries, this relationship was even stronger, with an OR of 0.59 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001), indicating a 70 % increase in the odds of late surgery for every 1000 USD decrease in GDP per capita.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a strong negative correlation between national income status and delayed access to primary cleft palate surgery, indicating a high degree of inequity in access to surgery, particularly in low\u2010 and lower\u2010middle\u2010income countries. As the importance of surgery in global health is increasingly recognized, an equity perspective must be included in the global dialog to ensure that the world\u2019s poor have fair and equitable access to essential surgical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-015-3374-0","type":"journal-article","created":{"date-parts":[[2015,12,15]],"date-time":"2015-12-15T13:09:41Z","timestamp":1450184981000},"page":"1047-1052","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Inequitable Access to Timely Cleft Palate Surgery in Low\u2010 and Middle\u2010Income Countries"],"prefix":"10.1002","volume":"40","author":[{"given":"Lucas C.","family":"Carlson","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Brigham &amp; Women\u2019s Hospital 75 Francis St., NH\u20102 02115 Boston MD USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin W.","family":"Hatcher","sequence":"additional","affiliation":[{"name":"Operation Smile, Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Tomberg","sequence":"additional","affiliation":[{"name":"Operation Smile, Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Kabetu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Kenyatta National Hospital Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Ayala","sequence":"additional","affiliation":[{"name":"Operation Smile, Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Vander Burg","sequence":"additional","affiliation":[{"name":"Operation Smile, Inc. 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