{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:32:15Z","timestamp":1792549935840,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T00:00:00Z","timestamp":1485216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T00:00:00Z","timestamp":1485216000000},"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":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Most people who lack adequate access to surgical care reside in low\u2010 and lower\u2013middle\u2010income countries. Few studies have analyzed the barriers that determine the ability to access surgical treatment. We seek to determine which barriers prevent access to cleft care in a resource\u2010limited country to potentially enable barrier mitigation and improve surgical program design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional, multi\u2010site study of families accessing care for cleft lip and palate deformities was performed in Vietnam. A survey instrument containing validated demographic, healthcare service accessibility, and medical\/surgical components was administered. The main patient outcome of interest was receipt of initial surgical treatment prior to 18\u00a0months of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 453 subjects enrolled in the study, 216 (48%) accessed surgical care prior to 18\u00a0months of age. In adjusted regression models, education status of the patient\u2019s father (OR 1.64; 95% CI 1.1\u20132.5) and male sex (OR 1.61; 95% CI 1.1\u20132.4) were both associated with timely access to care. Distance and associated cost of travel, to either the nearest district hospital or to the cleft surgical mission site, were not associated with timing of access. In a sensitivity analysis considering care received prior to 24\u00a0months of age, cost to attend the surgical mission was additionally associated with timely access to care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Half of the Vietnamese children in our cohort were not able to access timely surgical cleft care. Barriers to accessing care appear to be socioeconomic as much as geographical or financial. This has implications for policies aimed at reaching vulnerable patients earlier.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-3896-8","type":"journal-article","created":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T17:33:45Z","timestamp":1485279225000},"page":"1435-1446","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Patient Barriers to Accessing Surgical Cleft Care in Vietnam: A Multi\u2010site, Cross\u2010Sectional Outcomes Study"],"prefix":"10.1002","volume":"41","author":[{"given":"Jordan W.","family":"Swanson","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital Los Angeles Los Angeles CA USA"},{"name":"Shriner\u2019s Hospital for Children Los Angeles CA USA"},{"name":"Division of Plastic Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA"},{"name":"McGregor Comprehensive Cleft Center Operacion Sonrisa Nicaragua Colonia Bolonia Managua Nicaragua"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A.","family":"Yao","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital Los Angeles Los Angeles CA USA"},{"name":"Division of Plastic Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyn","family":"Auslander","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital Los Angeles Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Wipfli","sequence":"additional","affiliation":[{"name":"Institute of Global Health Keck School of Medicine of the University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thi\u2010Hai\u2010Duc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Operation Smile Vietnam Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Hatcher","sequence":"additional","affiliation":[{"name":"Division of Research and Outcomes Operation Smile International Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Vanderburg","sequence":"additional","affiliation":[{"name":"Division of Research and Outcomes Operation Smile International Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital Los Angeles Los Angeles CA USA"},{"name":"Shriner\u2019s Hospital for Children Los Angeles CA USA"},{"name":"Division of Plastic Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1,24]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2015.04.011"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101732\u20108"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0091862"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(14)70213\u2010X"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010011\u20101010\u20101"},{"key":"e_1_2_7_7_2","volume-title":"Global health estimates for deaths by cause, age, and sex for years 2000\u20132011","author":"World Health Organization","year":"2013"},{"key":"e_1_2_7_8_2","volume-title":"Congenital anomalies, Fact Sheet No. 370","author":"World Health Organization","year":"2012"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1596\/978-1-4648-0346-8_ch8"},{"key":"e_1_2_7_10_2","first-page":"216","article-title":"Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review","volume":"24","author":"Vanderas AP","year":"1987","journal-title":"Cleft Palate J"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010009\u20100333\u20107"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000184"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002656"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003038"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182402dd1"},{"key":"e_1_2_7_17_2","unstructured":"World Bank.Country and lending group data.http:\/\/data.worldbank.org\/about\/country\u2010and\u2010lending\u2010groups. Accessed 19 Aug 2015"},{"key":"e_1_2_7_18_2","unstructured":"World Health Organization.Multi\u2010country survey study World Health Survey questionnaires. Health System Responsiveness Unit.http:\/\/www.who.int\/responsiveness\/surveys\/en\/. Accessed 20 Aug 2015"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36693"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0277\u20109536(90)90052\u2010T"},{"key":"e_1_2_7_21_2","unstructured":"VeauV(1931)Division palatine. Anatomie chirurgie phonetique. En collaboration avec Mme. Masson et Cie Borel Paris"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545\u20101569(1992)029<0435:PAPSOT>2.3.CO;2"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010198207000\u201000015"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010009\u20100198\u20109"},{"key":"e_1_2_7_25_2","volume-title":"Comprehensive cleft care","author":"Salyer KE","year":"2015"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132362"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000391"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000221623.15710.b9"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36865"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.2307\/1972764"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1037\/e584032011\u2010022"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.304.6827.587"},{"key":"e_1_2_7_33_2","volume-title":"Essential surgery: disease control priorities","author":"McCord C","year":"2015"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102395\u20109"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(15)00079\u20100"},{"key":"e_1_2_7_36_2","volume-title":"Comprehensive cleft care","author":"Cohen MA","year":"2015"},{"key":"e_1_2_7_37_2","volume-title":"World Bank Atlas","author":"World Bank","year":"2014"},{"key":"e_1_2_7_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101876\u20106"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2006.0138"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2015.0296"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis1193"},{"issue":"12","key":"e_1_2_7_42_2","first-page":"1145","article-title":"Community\u2010based treatment of advanced HIV disease: introducing DOT\u2010HAART (Directly Observed Therapy with Highly Active Antiretroviral Therapy)","volume":"79","author":"Farmer P","year":"2001","journal-title":"Bull World Health Organ"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-017-3896-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-3896-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-3896-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-017-3896-8","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T17:11:03Z","timestamp":1704906663000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-017-3896-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,24]]},"references-count":41,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1007\/s00268-017-3896-8"],"URL":"https:\/\/doi.org\/10.1007\/s00268-017-3896-8","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,24]]},"assertion":[{"value":"24 January 2017","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"We declare no competing interests, real or potential.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}