Obstacles to surgical services in a rural Cameroonian district hospital

There are significant obstacles to the delivery of surgical care in low income countries. Few studies have defined or characterized these constraints. The present study aimed to identify financial and demographic factors limiting the utilization of surgical services in rural Cameroon.

A review was performed of all surgical records for patients presenting for surgery at the District Hospital of Kolofata in rural Cameroon over the 3-year study period (2004-2007). Disability-adjusted life years (DALYs) were calculated using disease- and patient-specific outcomes while accounting for postoperative morbidity. Univariate and multivariate analysis identified factors associated with failure to return for care.

During the study period, 1,213 patients presented for preoperative evaluation, were informed of the cost to be paid preoperatively, and had surgery scheduled. Of these, 544 patients did not return for treatment, representing 2,163 DALYs potentially lost. Multivariate analysis revealed significant factors associated with increased likelihood of not returning for care as required preoperative payment >$US 310 (OR 0.44-0.86) and a recommended procedure for cancer (OR 0.47-0.86) or cutaneous disease (OR 0.28-0.95). Factors associated with increased odds of returning were male gender (OR 1.03-1.98), preoperative payment <$US 50 (OR 2.86-16.2), and a procedure with low DALYs (OR 1.71-9.89). The average cost per DALY for all operations performed was $US 27.13.

Although surgery addresses a significant disease burden and is reported to be a cost-effective public health intervention, utilization is limited by high costs, demographic factors, and patient perceptions of surgical diseases.