C. Long1, T. T. Ngwa2, E. K. Lawong2, J. A. Brown2, S. M. Wren1 1Stanford University,Palo Alto, CA, USA 2Mbingo Baptist Hospital,Mbingo, NORTH-WEST, Cameroon
Introduction: Delay in definitive management for certain surgical diseases is correlated with worse outcomes and can be present in health systems regardless of country economic status. Few studies have critically examined delays in Sub-Saharan Africa. Reasons are often multi-factorial including cultural, socioeconomic, and access issues. This study investigates factors contributing to delays in treatment at Mbingo Baptist Hospital (MBH), a referral hospital in Cameroon and West Central Africa.
Methods: 235 patients and/or caregivers were interviewed (6/23/14-8/4/14) using a 34-item survey. All patients >age 15 admitted with trauma, cancer, or emergent surgical conditions (defined as requiring a definitive procedure within 48 hours of admission) were interviewed and demographics, history of current illness, previous care received, and factors that contributed to delayed arrival were collected.
Results: Delays were scored as <1 day, 1-6 days, 1-2 weeks, 2 weeks-1 month, 1-6 months, 6-12 months, 1-5 years, and 5-10 years. Of the 235 patients, 105 (44.6%) had trauma, 78 (33.2%) emergent conditions, and 52 (22.1%) cancer. Presence of symptoms were found >1 month in100% of cancer patients, >2 weeks in 78.2% of emergent patients, and > 1 week in 47.6% of trauma patients before presentation to MBH. The most common reason for seeking medical help was pain (71.8%, n=168), broken down to 67% (35/52) for cancer, 71.4% (75/105) for trauma, and 74.3% (58/78) for emergencies. The greatest factor for delay was at least one visit to prior healthcare facility in 88.9%. By condition, it was 100% (52/52) for cancer, 85.7% (90/105) for trauma, and 85.9% (67/78) for emergencies. A total of 65.5% (n=137) received previous care at a government hospital, 81.3% (n=170) received medication to “treat” their condition, and 16.3% (n=34) received a surgical operation. 99% (n=207) did not feel that their health concerns were addressed at that encounter. A total of 56.5% (n=118) had received care in 2 or more different places with only 10.0% (n=21) reporting that their condition improved afterwards. Other common factors identified were transportation related (46%), feeling that they were not “sick” enough (34.9%) and cost related (25.5%).
Conclusions: Significant delays in receiving definitive treatment were most often due to the time spent on previous failed attempts at care. Deciding where to seek medical help is complex, as patients and family members balanced factors such as cost, distance, severity and urgency of the condition, and the reputation of different facilities. This information can be used to inform policy discussions about optimal healthcare organization within the country.