title: Barriers to essential surgical care experienced by women in the two northernmost regions of Ghana: a cross-sectional survey.
abstract: Women in developing countries might experience certain barriers to care more frequently than men. We aimed to describe barriers to essential surgical care that women face in five communities in Ghana.
  
  
  
  Questions regarding potential barriers were asked during surgical outreaches to five communities in the northernmost regions of Ghana. Responses were scored in three dimensions from 0 to 18 (i.e., 'acceptability,' 'affordability,' and 'accessibility'; 18 implied no barriers). A barrier to care index out of 10 was derived (10 implied no barriers). An open-ended question to elicit gender-specific barriers was also asked.
  
  
  
  Of the 320 participants approached, 315 responded (response rate 98 %); 149 were women (47 %). Women had a slightly lower barriers to surgical care index (median index 7.4; IQR 3.9-9.1) than men (7.9; IQR 3.9-9.4; p = 0.002). Compared with men, women had lower accessibility and acceptability dimension scores (14.4/18 vs 14.4/18; p = 0.001 and 13.5/18 vs 14/18; p = 0.05, respectively), but similar affordability scores (13.5/18 vs 13.5/18; p = 0.13). Factors contributing to low dimension scores among women included fear of anesthesia, lack of social support, and difficulty navigating healthcare, as well as lack of hospital privacy and confidentiality.
  
  
  
  Women had a slightly lower barriers to surgical care index than men, which may indicate greater barriers to surgical care. However, the actual significance of this difference is not yet known. Community-level education regarding the safety and benefits of essential surgical care is needed. Additionally, healthcare facilities must ensure a private and confidential care environment. These interventions might ameliorate some barriers to essential surgical care for women in Ghana, as well as other LMICs more broadly.
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. drgyedu@gmail.com.|Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana. drgyedu@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Abantanga
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Godfred
authors.initials: G
authors.lastname: Boakye
authors.affiliation: Department of Surgery, University of California, San Francisco, CA, USA.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Easmon
authors.initials: E
authors.lastname: Otupiri
authors.affiliation: Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Anita Eseenam
authors.initials: AE
authors.lastname: Agbeko
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Surgery, Columbia University, New York, NY, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Kushner
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Barclay
authors.initials: B
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003697:Delphi Technique; D005260:Female; D005869:Ghana / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D017678:Sex Distribution; D013514:Surgical Procedures, Operative / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Barriers; Essential surgical care; Ghana; LMIC; Women