SURGICAL INFECTIONS AT A REGIONAL HOSPITAL IN GAUTENG: REASONS FOR DELAY TO CARE AND PROFILE OF PATHOLOGY.

BACKGROUND: Infection is a common cause for the admission of surgical patients who were initially seen and managed at the primary health care level. Delay to care significantly increases the health care burden of surgical sepsis on affected individuals, the health system and society.

METHOD: A prospective descriptive study was performed by means of a confidential questionnaire presented to qualifying patients between February 2014 and October 2016. No minors were included in the study. Descriptive statistics were generated utilising MS Excel. Analytic statistics were facilitated using the t-test, Chi Squared test, Fischer's Exact Test and logistic regression.

RESULTS: A total of 89 patients agreed to participate. Abscesses (23/89, 25.8%), diabetic foot (20/89, 22.4%), cellulitis (14/89, 15.7%) and septic burns (10/89, 11.2%) were the most common categories of infection requiring admission. The majority of patients admitted were Black African males (39/89, 43.8%), with no medical aid (88/89, 98.8%), no formal employment (52/89, 58.4%), inhabiting some form of formal housing (80/89, 89.8%), from poor households (defined as annual income < R60 000/year) (66/89, 74.1%), were in charge of decisions regarding personal health (71/89, 79.7%), and first sought help at the primary health care level (local clinic or private physician) (63/89, 70.7%). In total 68.5% (61/89) of patients admitted had a significant delay of > 48 hours from onset of symptoms to presentation to a health care worker. Furthermore, 46.1% (41/89) of patients experienced a significant delay of > 24 hours from presentation to health care worker to admission. The most common reason for delay to care in both groups (50/61, 81.9% and 25/41, 60.1%, respectively) was patients' belief that the problem would resolve itself.

CONCLUSION: Urban populations are different to rural populations in terms of barriers to access to health care. Utilisation of primary health care services (private and public) as a first point of contact with the health care system is high. Patients' perception of their own health is an important determinant of their health seeking behaviour.