{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:16:31Z","timestamp":1766578591874},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,25]],"date-time":"2018-08-25T00:00:00Z","timestamp":1535155200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,8,25]],"date-time":"2018-08-25T00:00:00Z","timestamp":1535155200000},"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":[[2019,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>There is a paucity of data regarding sex\u2010based disparities in surgical care delivery, particularly in low\u2010 and middle\u2010income countries. This study sought to determine whether sex disparities are present among patients presenting with surgical conditions in Malawi. <jats:italic>Hypothesis<\/jats:italic> compared to men, fewer women present to Kamuzu Central Hospital (KCH) with peritonitis and have longer delays in presentation for definitive care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study performs a retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to KCH in Lilongwe, Malawi, from September 2013 to April 2016. Multivariable linear and logistic regressions were used to assess the effect of sex on mortality, length of stay, operative intervention, complications, and time to presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 462 patients presenting with general surgery conditions and peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had significantly higher odds of non\u2010operative management when compared to men (OR 2.17, 95%CI 1.30\u20133.62, <jats:italic>P<\/jats:italic>\u2009=\u20090.003), delays in presentation (adjusted mean difference 136 h, 95%CI 100\u2013641, <jats:italic>P<\/jats:italic>\u2009=\u20090.05), delays to operation (adjusted mean difference 1.91\u00a0days, 95%CI 1.12\u20133.27, <jats:italic>P<\/jats:italic>\u2009=\u20090.02), and longer lengths of stay (adjusted mean difference 1.67\u00a0days, 95%CI 1.00\u20132.80, <jats:italic>P<\/jats:italic>\u2009=\u20090.05). There were no differences in complications or in\u2010hospital or Emergency Department mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sex disparities exist within the general surgery population at KCH in Lilongwe, Malawi. Fewer women present with surgical problems, and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Future studies to determine mortality in the community and driving factors of sex disparities will provide more insight.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4775-7","type":"journal-article","created":{"date-parts":[[2018,8,25]],"date-time":"2018-08-25T16:31:59Z","timestamp":1535214719000},"page":"60-66","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Sex Disparities in Access to Surgical Care at a Single Institution in Malawi"],"prefix":"10.1002","volume":"43","author":[{"given":"Trista D.","family":"Reid","sequence":"first","affiliation":[{"name":"Department of Surgery University of North Carolina\u2010 Chapel Hill 4001 Burnett\u2010Womack Building CB# 7050 27599\u20107050 Chapel Hill NC USA"},{"name":"Department of Surgery Kamuzu Central Hospital P.O. Box 149 Lilongwe Malawi"},{"name":"UNC School of Medicine, University of North Carolina 4008 Burnett Womack Building 27599 Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry M.","family":"Wren","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University 300 Pasteur Drive 94304 Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Grudziak","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina\u2010 Chapel Hill 4001 Burnett\u2010Womack Building CB# 7050 27599\u20107050 Chapel Hill NC USA"},{"name":"Department of Surgery Kamuzu Central Hospital P.O. 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Box 149 Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony G.","family":"Charles","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina\u2010 Chapel Hill 4001 Burnett\u2010Womack Building CB# 7050 27599\u20107050 Chapel Hill NC USA"},{"name":"Department of Surgery Kamuzu Central Hospital P.O. Box 149 Lilongwe Malawi"},{"name":"UNC School of Medicine, University of North Carolina 4008 Burnett Womack Building 27599 Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,25]]},"reference":[{"key":"e_1_2_6_2_2","unstructured":"WhiteheadM(1990)The concepts and principles of equity in health. (PDF Report). 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