Background
Few studies have examined critically the delays in definitive management for surgical
diseases in Sub-Saharan Africa. This study investigates factors contributing to delays
at Mbingo Baptist Hospital, a tertiary referral hospital in Cameroon.
Methods
During a 6-week period, we randomly interviewed 220 patients (39.2%) admitted to the
surgical or orthopedic service and/or their caregivers. All patients >age 15 years
admitted with a diagnosis of cancer or urgent operative condition (defined as requiring
a definitive operation within 48 hours of admission) including trauma were interviewed.
Delay was defined as receiving treatment >7 days after symptoms appeared in the urgent
cohort and >1 month for the cancer cohort.
Results
In the urgent cohort, 60.3% patients had delays >7 days to hospital presentation.
Compared with nondelayed patients, delayed patients were more likely to have sought
care >1 day after symptoms appeared (45.4% vs 6.3%, P < .0001) and to have received previous medical care (92.8% vs 73.4%, P = .0007). Of all patients who received previous care, those with delays, compared
those with no delays, visited ≥2 other providers (50.5% vs 18.8%, P < .0001), received a surgical procedure at previous episode(s) of care (21.1% vs
6.4%, P = .026), and felt no improvement after this care (80.4% vs 61.0%, P = .003). In the cancer cohort, 100% experienced >1 month delay. 100% had received
medical care prior to arriving at Mbingo Baptist Hospital, 81.4% sought care from
at least 3 different facilities, and none believed this care addressed their health
concerns.
Conclusion
Significant delays most often were caused by time spent on previous failed attempts
at care. This information can be used to inform policy discussions about optimal health
care organization within the country.
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Article info
Publication history
Published online: June 08, 2015
Accepted:
April 5,
2015
Footnotes
Source of financial support: Stanford Center for African Studies Summer Fellowship.
Identification
Copyright
Published by Elsevier Inc.
