Gender Disparities Affect Access to Otolaryngology-Head & Neck Surgery in an Ethiopian Tertiary Referral Center

Introduction: Patients face numerous obstacles when trying to access surgical care in low and middle-income countries (LMICs), some of which include a lack of infrastructure, a shortage of qualified personnel, or inability to reach care due to cost, distance, or transportation constraints. Gender disparities have been suggested to further worsen these barriers, particularly for women in LMICs, however research on the extent to which gender influences access to care in LMICs is limited.

Methods: Otolaryngology residents and attending physicians administered demographic surveys to patients from May 2024 to January 2025 at a tertiary academic medical center in Mekelle, Ethiopia. Data was retrospectively analyzed with RStudio and Welch’s two-sample t-tests with a p-value of 0.05 for statistical significance.

Results: 253 patients met inclusion criteria for this study (101 female, 152 male). Average number of days from onset of symptoms until initial consultation was longer for females (1382 days) compared to males (904 days) and this was statistically significant (t= 2.42, p= 0.016, 95% CI [88.4, 867.8]). Average number of days from initial consultation until surgery was shorter for females (166 days) compared to males (202 days); however, this was not statistically significant (t= -0.74, p= 0.46, 95% CI [-59.9, 132.7]). Common reasons for delayed care included having to visit one or more healthcare centers who could not treat the issue (n=55), a long wait time before treatment (n=46), and a delay in realizing that medical care was needed (n=40).

Conclusions: Women who accessed otolaryngology care in Mekelle had a statistically significantly longer duration of symptoms before being able to meet with an otolaryngologist. However, once they had their initial consultation, they underwent surgery sooner on average than their male counterparts. Our preliminary data suggests that certain factors, such as having to visit multiple healthcare facilities, experiencing a long wait time, and not knowing that care is needed, may be contributing to this significantly longer duration of symptoms before presentation to an otolaryngologist.