Community experiences of surgery in peri-urban Cape Town
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i1.3631Keywords:
Global surgery, Community Experiences, Surgery, Low resourced settingsAbstract
Background. Surgical care is critical for addressing universal access to healthcare, but access to safe and timely surgery is limited, especially in poorly resourced settings.
Objective. To determine the surgical experiences of individuals in a peri-urban community in Cape Town, South Africa.
Methods. A cross-sectional household survey of individuals in a peri-urban Cape Town community was conducted with door-to door interviews by trained community assistants, who provided multilingual translation of study materials as needed. The study (i) describes the surgical burden of disease and outcomes; (ii) assesses health-seeking behaviour and barriers to care using the Three Delays framework; and (iii) uses descriptive statistics to characterise respondent demographics and surgical experiences and χ2 tests to compare awareness, attitudes and acceptability across genders and locations.
Results. Data from 432 valid responses of 450 surveys conducted showed that chronic diseases were common, affecting 240/431 (56%), with a higher prevalence in females than in males (171/285 (60%) v. 63/133 (47%), p<0.05). Most participants (208/432, 44%) lived within 10 km of their nearest healthcare facility, predominantly public facilities (417/432, 97%). The Three Delays framework showed that 87/432 (20%) delayed seeking surgical care, 114/432 (26%) experienced delays reaching facilities and 95/432 (32%) faced delays in receiving appropriate care, while 95/432 (22%) reported no delays. The surgical burden was substantial, with 260/428 (60%) having undergone surgery in their lifetime and 195 surgical procedures performed in the last 5 years. Postoperative disability affected 43/432 (10%) of participants, primarily manifesting as body function impairments (22/43, 51.2%) and activity limitations (7/43, 16.3%). Only 67% understood post-surgical treatment protocols.
Conclusion. This study reveals significant challenges in surgical care delivery in this peri-urban community. Key findings include a high chronic disease burden, substantial delays in accessing surgical care and significant postoperative disability rates. These results provide the first comprehensive assessment of surgical experiences in peri-urban Cape Town, highlighting the need for comprehensive interventions targeting chronic disease and surgical care, even in peri-urban areas close to public health facilities.
References
1. AlkireBC,RaykarNP,ShrimeMG,etal.Globalaccesstosurgicalcare:Amodellingstudy.LancetGlob Heal 2015;3(6):e316-e323. https://doi.org/10.1016/S2214-109X(15)70115-4
2. Ma X, Vervoort D, Reddy CL, Park KB, Makasa E. Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective. Int J Surg 2020;79(May):43-46. https://doi.org/10.1016/j.ijsu.2020.05.037
3. Shrime MG, Bickler SW, Alkire BC, Mock C. Global distribution of surgeons, anaesthesiologists. Lancet Glob Health 2015;3(Suppl 2):S9-S11. https://doi.org/10.1016/S2214-109X(14)70349-3
4. Gabrysch S, Campbell OMR. Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009;9:34. https://doi.org/10.1186/1471-2393-9-34
5. Moyer CA, Mustafa A. Drivers and deterrents of facility delivery in sub-Saharan Africa: A systematic review. Reprod Health 2013;10:40. https://doi.org/10.1186/1742-4755-10-40
6. Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 2011;35(5):941-950. https://doi.org/10.1007/ s00268-011-1010-1
7. Ologunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low- and middle- income countries: Burden and barriers. Int J Surg 2014;12(8):858-863. https://doi.org/10.1016/j. ijsu.2014.07.009
8. Atinyagrika Adugbire B, Aziato L. Surgical patients’ perspectives on nurses’ education on post- operative care and follow up in Northern Ghana. BMC Nurs 2018;17(1):1-9. https://doi.org/10.1186/ s12912-018-0299-6
9. Ladak LA, Gallagher R, Hasan BS, Awais K, Abdullah A, Gullick J. Exploring the influence of socio- cultural factors and environmental resources on the health-related quality of life of children and adolescents after congenital heart disease surgery: Parental perspectives from a low middle income country. J Patient-Reported Outcomes 2020;4(1):72. https://doi.org/10.1186/s41687-020-00239-0
10. Skinner DL, De Vasconcellos K, Wise R, et al. Critical care admission of South African surgical patients: Results of the SA surgical outcomes study. S Afr Med J 2017;107(5):411-419. https://doi. org/10.7196/SAMJ.2017.v107i5.11455
11. Biccard BM, Madiba TE. The South African Surgical Outcomes Study: A 7-day prospective observational cohort study. S Afr Med J 2015;105(6):465-475. https://doi.org/10.7196/samj.9435
12. StatisticsSouthAfrica.Census2022:StatisticalReleaseP0301.4.Pretoria:StatisticsSouthAfrica,2023.
https://census.statssa.gov.za/assets/documents/2022/P03014_Census_2022_Statistical_Release.pdf
(accessed 19 December 2025).
13. Barnes-Josiah D, Myntti C, Augustin A. The ‘Three delays’ as a framework for examining maternal
mortality in Haiti. Soc Sci Med 2014;46(8):981-993. https://doi.org/10.1016/S0277-9536(97)10018-1 14. Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN. Disease Control Priorities, third edition: Essential surgery. Washington, DC: World Bank Group, 2015. https://doi.org/10.1596/978-
1-4648-0346-8
15. World Health Organization. International Classification ff Functioning, Disability and Health. Geneva: WHO, 2007. https://www.who.int/standards/classifications/international-classification-of- functioning-disability-and-health (accessed 13 October 2024).
16. Asogwa OA, Boateng D, Marzà-Florensa A, et al. Multimorbidity of non-communicable diseases in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open 2022;12(1):1-16. https://doi.org/10.1136/bmjopen-2021-049133
17. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non- communicable diseases in South Africa. Lancet 2009;374(9693):934-947. https://doi.org/10.1016/ S0140-6736(09)61087-4
18. Isiagi M, Zolo Y, Maswime S. Geospatial determinants of health: A global surgery lens. J Coll Med S Africa 2024;2(1):1-3. https://doi.org/10.4102/jcmsa.v2i1.49
19. Clarke-Deelder E, Afriyie DO, Nseluke M, Masiye F, Fink G. Health care seeking in modern urban LMIC settings: Evidence from Lusaka, Zambia. BMC Public Health 2022;22(1):1205:1-13. https://doi. org/10.1186/s12889-022-13549-3
20. Mubiri P, Kajjo D, Okuga M, et al. Bypassing or successful referral? A population-based study of reasons why women travel far for childbirth in Eastern Uganda. BMC Pregnancy Childbirth 2020;20(1):497. https://doi.org/10.1186/s12884-020-03194-2
21. Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC, Galea S. Bypassing primary care facilities for childbirth: A population-based study in rural Tanzania. Health Policy Plan 2009;24(4):279-288. https://doi.org/10.1093/heapol/czp011
22. Varela C, Young S, Mkandawire N, Groen RS, Banza L, Viste A. Transportation barriers to access health care for surgical conditions in Malawi: A cross-sectional nationwide household survey. BMC Public Health 2019;19:264. https://doi.org/10.1186/s12889-019-6577-8
23. Cotache-Condor C, Rice HE, Schroeder K, et al. Delays in cancer care for children in low-income and middle-income countries: Development of a composite vulnerability index. Lancet Glob Heal 2023;11(4):e505-e515. https://doi.org/10.1016/S2214-109X(23)00053-0
24. Drake TM, Fitzgerald JEF, Poenaru D, et al. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Heal 2016;1(4):1-12. https://doi.org/10.1136/bmjgh-2016-000091
25. Kruk TM, Fitzgerald JEF, Poenaru D, et al. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Heal 2016;1(4):1-12. https://doi.org/10.1136/bmjgh-2016-000091
26. South Africa. Constitution of Republic of South Africa, 1996. https://www.gov.za/sites/default/files/ images/a108-96.pdf (accessed 10 July 2024).
27. Ngobeni V, Breitenbach MC, Aye GC. Technical efficiency of provincial public healthcare in South Africa. Cost Eff Resour Alloc 2020;28(18):3. https://doi.org/10.1186/s12962-020-0199-y
28. Kumar A. The transformation of the Indian healthcare system. Cureus 2023;15(5):3-6. https://doi. org/10.7759/cureus.39079
29. Akinwumi AI, Olaolorun AD, Adesina SA, Durodola AO. Strong primary care services, an important feature of primary healthcare: What can Nigeria learn from Israel? Front Public Health 2022;10:1006095. https://doi.org/10.3389/fpubh.2022.1006095
30. Harrison SR, Jordan AM. Chronic disease care integration into primary care services in sub-Saharan Africa: A ‘best fit’ framework synthesis and new conceptual model. Fam Med Community Health 2022;10(3):1-11. https://doi.org/10.1136/fmch-2022-001703
31. Ng-Kamstra JS, Arya S, Greenberg SLM, et al. Perioperative mortality rates in low income and middle- income countries: A systematic review and meta-analysis. BMJ Glob Health 2018;3(3):1-12. https:// doi.org/10.1136/bmjgh-2018-000810
32. Chu KM, Jayaraman S, Kyamanywa P, Ntakiyiruta G. Building research capacity in Africa: Equity and global health collaborations. PLoS Med 2014;11(3):1-4. https://doi.org/10.1371/journal.pmed.1001612 33. Stewart B, Khanduri P, McCord C, et al. Global disease burden of conditions requiring emergency
surgery. Br J Surg 2014;101(1):9-22. https://doi.org/10.1002/bjs.9329
34. Isiagi M, Sport H, Med H. Global surgery in Africa: Access to surgery, an opportunity to adopt a
participatory community-based approach. S Afr J Public Health 2025;8(1):11-13. https://doi.
org/10.7196/SHS.2025.v8i1.2539
35. Ng-Kamstra JS, Greenberg SLM, Abdullah F, et al. Global surgery 2030: A roadmap for high income country actors. BMJ Glob Heal 2016;1(1):1-11. https://doi.org/10.1136/bmjgh-2015-000011
Downloads
Published
Issue
Section
License
Copyright (c) 2026 M Isiagi, B Biccard, M Kinney, S Le Roux, N Mdayi, M Kinnes, O Mbamalu, J Gizamba, R Veitch, E Akurut, L Fadiran, Y Pulani, S Maswime
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
