Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Dewan MC, Rattani A, Fieggen G, Arraez MA, Servadei F, Boop FA, et al. . Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive summary of the global neurosurgery initiative at the program in global surgery and social change. J Neurosurg. (2018) 130:1055–64. 10.3171/2017.11.JNS171500 - DOI - PubMed
    1. Attebery JE, Mayegga E, Louis RG, Chard R, Kinasha A, Ellegala DB. Initial audit of a basic and emergency neurosurgical training program in rural Tanzania. World Neurosurg. (2010) 73:290–5. 10.1016/j.wneu.2010.02.008 - DOI - PubMed
    1. Mansouri A, Chan V, Njaramba V, Cadotte DW, Albright AL, Bernstein M. Sources of delayed provision of neurosurgical care in a rural Kenyan setting. Surg Neurol Int. (2015) 6:32. 10.4103/2152-7806.152141 - DOI - PMC - PubMed
    1. Rabiu TB, Adetunmbi B. Posttraumatic seizures in a rural nigerian neurosurgical service. World Neurosurg. (2017) 104:367–71. 10.1016/j.wneu.2017.04.133 - DOI - PubMed
    1. Punchak M, Mukhopadhyay S, Sachdev S, Hung Y-C, Peeters S, Rattani A, et al. . Neurosurgical care: availability and access in low-income and middle-income countries. World Neurosurg. (2018) 112:e240–54. 10.1016/j.wneu.2018.01.029 - DOI - PubMed

LinkOut - more resources