Citation

Dickson DC, Christie SA, Chichom Mefire A, Oben E, Embolo FN, Fonje AN, O'Sullivan P, Akumbu PW, Essi MJ, Dicker R, Juillard C. J. Surg. Res. 2019; 244: 528-539.

Affiliation

Department of Surgery, University of California Los Angeles, Los Angeles, California. Electronic address: c.juillard@gmail.com.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jss.2019.06.098

PMID

31351396

Abstract

BACKGROUND: Populations in Cameroon, a lower middle-income country in Central Africa, have a higher than average burden of traumatic injury, suffer from more severe injuries, and face substantial barriers to accessing formal health care services after injury. The aim of this study was to identify and describe how recently injured Cameroonians use and adapt the formal and informal medical systems and what motivates these transitions.

MATERIALS AND METHODS: Recently injured people or their surrogates residing in Southwest Region, Cameroon, were recruited from a larger community-based survey on injury. Semistructured interviews were conducted with 39 recently injured persons or their adult family members. Interviews were recorded, transcribed, and iteratively coded to identify major themes.

RESULTS: Most injured persons had complex therapeutic itineraries involving one or more transitions, and nine of 35 injured persons used formal care exclusively. Transitions away from formal care were driven by (1) anticipated costs beyond means, (2) unacceptable length of proposed treatment, (3) poorly supported referrals, (4) dissatisfaction with treatment progress or outcome, and (5) belief that traditional methods work additively with formal care. Factors motivating people to engage with formal care included (1) perceived high value of care for cost, (2) desire for reliable diagnostic tests, (3) social support during hospitalization, and (4) financial support from family or a stranger responsible for the injury.

CONCLUSIONS: These results highlight specific opportunities to improve engagement in formal care after injury and better support injured Cameroonians through the strengthening of the formal care referral process and health financing organization.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

Global health; Injury; Therapeutic itinerary; Traditional healers; Traditional medicine; Trauma care