Barriers to Timely Presentation of Patients with Surgical Conditions at Tamale Teaching Hospital in Northern Ghana

Stephen Tabiri, Ali Jalali, Richard E. Nelson, Michael C. Damah, Francis A. Abantanga, Raymond R. Price, Micah G. Katz

Improving access to surgical services and understanding the barriers to receiving timely care are necessary to save lives. The aim of this study was to assess barriers to timely presentation to an appropriate medical facility using the Three-Delay model, for patients presenting to Tamale Teaching Hospital, in northern Ghana. In 2013, patients with delays in seeking surgical care were prospectively identified. Pairwise correlation coefficients between delay in presentation and factors associated with delay were conducted and served as a foundation for a multivariate log-linear regression model. A total of 718 patients presented with an average delay of 22.1 months. Delays in receiving care were most common (56.4%), while delays in seeking care were seen in 52.3% of patients. "Initially seeking treatment at the nearest facility, but appropriate care was unavailable" was reported by 56.4% and predicted longer delays (p < 0.001). 42.9% of patients had delays secondary to treatment from a traditional or religious healer, which also predicted longer delays (p < 0.001). On multivariate regression, emergent presentation was the strongest predictor of shorter delays (OR 0.058, p = 0.002), while treatment from a traditional or religious healer and initially seeking treatment at another hospital predicted longer delays (OR 7.6, p = 0.008, and OR 4.3, p  = 0.006, respectively). Barriers to care leading to long delays in presentation are common in northern Ghana. Interventions should focus on educating traditional and religious healers in addition to building surgical capacity at district hospitals.