Barriers to Management of Nontraumatic Neurosurgical Diseases at 2 Cameroonian Neurosurgical Centers: Cross-Sectional Study

Abstract

Although nontraumatic diseases affect fewer people than traumatic neurosurgical diseases, they require expertise more often. The authors sought to understand the barriers to nontraumatic neurosurgical diseases (NTNSDs) in a country with limited access to neurosurgical care. This cross-sectional study with retrospective data collection was carried out in 2 Cameroonian reference hospitals for a year. Multiple imputations were used to generate data for the missing variables-death and discharge with sequelae. Bivariate relationships were evaluated using the chi-square and Mann-Whitney U tests. Odds ratios were equally calculated, and the results were considered significant for a P value <0.05. NTNSDs represented 44.1% of neurosurgical activity. Our study included 177 patients with a mean age of 43.7 ± 21.2 years. More than half (53.1%) were female, 78% lived in a different region from that of the neurosurgical center, 18.1% had health insurance, 39.5% were referrals, and the mean symptom-to-admission delay was 409.0±1301.7 days. Most (87%) of the patients had undergone at least 1 of the diagnostic examinations prescribed to them. Men (P= 0.029) and rural dwellers (P=0.017) had shorter symptom-to-admission delays than women and urban dwellers, respectively. The mean length of stay was 18.2 ±13.4, and 80.8% of patients were treated surgically. Thirty-one (17.5%) patients died in the hospital: 9 were treated surgically, and 22 were treated conservatively or expectantly. Patients with NTNSD present at the definitive care facilities late. This delay is attributable to financial and geographic barriers.