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. 2022 Feb 15:8:703867.
doi: 10.3389/fsurg.2021.703867. eCollection 2021.

Identifying Barriers and Facilitators to the Improvement of Healthcare Delivery and Ethics in Two Cameroonian Neurosurgical Centers

Tutuwan J Ankeambom  1   2   3 , Mathieu Motah  3 , Mfouapon Ewane  4 , Nathan A Shlobin  2 , Celestin Bilong Mbangtang  2   5 , Olaoluwa Ezekiel Dada  2   6 , Kantenga Dieu Merci Kabulo  2   7 , Francklin Tetinou  2 , Geneviève Endalle  1   2 , Ulrick Sidney Kanmounye  2 , Luxwell Jokonya  8 , Ignatius N Esene  9
Affiliations

Identifying Barriers and Facilitators to the Improvement of Healthcare Delivery and Ethics in Two Cameroonian Neurosurgical Centers

Tutuwan J Ankeambom et al. Front Surg. .

Abstract

Background: Low-and middle-income countries (LMICs) are disproportionately affected by neurosurgical burden of disease. This health inequity causes constraints in decision-making. Neurosurgical ethics helps us to assess the moral acceptability and effectiveness of clinical decisions. We aimed to assess ethical neurosurgical care and its effect on patient satisfaction in Cameroon.

Methods: Two questionnaires hosted on Google Forms were administered among inpatients and staff at two Cameroonian neurosurgery centers. The questionnaires covered the factors influencing health outcomes and ethics. Data were collected from November 11, 2020, to March 11, 2021 and analyzed with SPSS v 26 to generate non-parametric tests with a threshold of significance at 0.05.

Results: Seventy patients and twenty healthcare providers responded to the survey. Most patients faced financial hardship (57.1%; 95% CI = 45.7-68.6%), and felt that this affected the care they received (P = 0.02). Patients noticed changes in the care plan and care delivery attributable to the neurosurgical units' lack of resources. According to the patients and caregivers, these changes happened 31.0-50.0% of the time (42.9%, 95% CI = 5.7-21.4%). The majority of patients were pleased with their involvement in the decision-making process (58.6%; 95% CI = 47.1-70.0%) and felt their autonomy was respected (87.1%; 95% CI = 78.6-94.3%).

Conclusion: Multiple challenges to neurosurgical ethical care were seen in our study. Multimodal interventions based on the four ethical principles discussed are necessary to improve ethical neurosurgical decision-making in this low resource setting.

Keywords: Cameroon; barriers; ethics; facilitators; health outcomes; neurosurgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Neurosurgical Centers in Cameroon by Region.
Figure 2
Figure 2
Pictorial Representation of DGH and LH.
Figure 3
Figure 3
Proportion of the annual household income spent on neurosurgical care.
Figure 4
Figure 4
Factors influencing the quality of care and service delivery.
Figure 5
Figure 5
Neurosurgery patient satisfaction with service delivery and the care environment.
See this image and copyright information in PMC

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