Understanding system-level barriers to pediatric neuro-oncology in Ghana: Qualitative insights from frontline healthcare professionals.
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BACKGROUND: Previous studies have shown significant gaps in the timely delivery of pediatric neurosurgical-oncologic care in sub-Saharan Africa despite the significant patient volume. The study aims to elucidate how the healthcare system and sociocultural norms and religious beliefs determine the outcomes of pediatric central nervous system (CNS) tumor care in Ghana based on the experiences of healthcare professionals. METHODS: This was a qualitative descriptive study; 15 healthcare professionals at Komfo Anokye Teaching Hospital (KATH) recruited through purposive sampling underwent audio-recorded semi-structured in-depth interviews. Interviews took place at the administrative offices of participants located on-site at KATH. Interviews were conducted by 2 co-investigators who had a professional relationship with the participants. Thematic saturation was reached after 9 interviews. Recordings were transcribed verbatim and coding and inductive thematic analysis was manually completed following Braun and Clarke's 6-step method. RESULTS: Thematic analysis yielded 3 overarching themes and 7 sub-themes with each illustrated with comments from study participants. The 3 overarching themes were: (1) The limitations of the healthcare system including limited availability of cancer treatment centers (2) Societal structures and norms which influence gender roles and healthcare decision making. (3) The impact of structural and social barriers to care leading to a 2 to 12 months delay in diagnosis with resultant poor treatment outcomes. CONCLUSION: The study adds to our understanding of the multifaceted barriers associated with pediatric neurosurgical-oncologic care in Ghana and how these barriers interact to impact outcomes. The study findings facilitate a comprehensive approach to designing and implementing health systems strengthening interventions to improve access to care.