World Journal of Surgery

, Volume 43, Issue 2, pp 346–352 | Cite as

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. KatzEmail author
Original Scientific Report



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.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Authors’ contribution

ST, MD, and FA designed the study and facilitated collection of data. MK wrote the manuscript with ST and AJ. All authors revised the drafted manuscript and provided critical revision of the manuscript for important intellectual content.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Stephen Tabiri
    • 1
  • Ali Jalali
    • 2
  • Richard E. Nelson
    • 3
  • Michael C. Damah
    • 1
  • Francis A. Abantanga
    • 1
  • Raymond R. Price
    • 4
  • Micah G. Katz
    • 4
    Email author
  1. 1.Department of Surgery, School of Medicine and Health Sciences and Tamale Teaching HospitalUniversity for Development StudiesTamaleGhana
  2. 2.Department of Economics, Health Economics Core, CCTS Population Health Research FoundationUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Internal Medicine, IDEAS Center, Veterans Affairs Salt Lake City Health Care SystemUniversity of UtahSalt Lake CityUSA
  4. 4.Department of Surgery, Center for Global SurgeryUniversity of UtahSalt Lake CityUSA

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