Introduction: Although the provision of neurosurgical care in Sub-Saharan Africa has improved significantly in the past few decades, there remains significant deficiencies with regards to accessibility of care, resulting in serious and irreversible consequences for patients. The consequences of delay in care also pose a large burden of cost to the public healthcare system. If sources of delay can be identified, appropriate targeted interventions can be implemented. In this study, we aim to identify and quantify the sources of delay to neurosurgical consultation and care at a rural setting in Kenya.
Methods: A mixed-methods, cross-sectional analysis of all patients admitted to the neurosurgical department at Kijabe Hospital (KH) was conducted: a retrospective analysis of admissions from October 1 to December 31, 2013 and a prospective analysis of admissions from June 2 to June 20, 2014. Sources of delay were identified and categorized. Students’ t-test and ANOVA were used to determine statistical significance.
Results: A total of 332 admissions were reviewed (237 retrospective, 95 prospective). The majority were pediatric admissions (median age: 3 months). Hydrocephalus (35%) and neural tube defects (27%) were the most common diagnoses. At least one source of delay was identified in 192 cases (58%); thirty-nine (12%) were affected by multiple sources. Delay attributable to primary care providers (PCPs), in isolation or combined with other sources, comprised 137 of all delayed cases (71%); misdiagnosis or incorrect management comprised 46 (34%) of these cases. Financial constraints contributed to delays in 25 of 95 prospective cases.
Conclusions: A substantial proportion of patients experienced delays in procuring pediatric neurosurgical care. Improvement in primary care physician knowledge base, implementation of a triage and referral process, and development of community-based funding strategies can potentially reduce these delays.
Patient Care: By characterizing and quantifying the delay in neurosurgical care in a rural setting, strategies and interventions may be explored to reduce the delay in order to minimize the burden of disease on individuals, the community, and a limited healthcare system. This is important given that in societies with minimal social support systems, even the slightest disability can impair the patients’ ability to function in the society. In addition to the individual patient, the consequences of delay in care pose a significant pressure on the patients’ families and dependents, along with a large burden of cost to the public healthcare system which is already limited in resources.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the sources of delay in neurosurgical care in a rural setting in Kenya, 2) Discuss the impact that delay has on individuals, the community, and the healthcare system, 3) Identify strategies and interventions that may be effective at reducing the delay.