Colorectal Cancer Screening in Ghana: Physicians' Practices and Perceived Barriers.

INTRODUCTION: Ghana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines. METHODS: We conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening. RESULTS: Almost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level). CONCLUSION: Despite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.

Assessment of Barriers to Essential Surgical Care in Two Communities in the Upper West Region, Ghana.

Systematic assessments of individual-and community-level barriers to surgical care (BSC) in low-and middle-income countries that might inform potential interventions are lacking. We used a novel tool to assess BSC systematically during a surgical outreach in two communities in Upper West region, Ghana. Results were scored in three dimensions of barriers to care (acceptability, affordability, and accessibility); higher dimension scores signified less salient barriers. A total index out of 10 was derived. In total, 169 individuals participated in Nadowli (68, 40%) and in Nandom (101, 60%). Nadowli had fewer BSC than Nandom (median index 7.8 vs 7.2; p < .001). Dimension scores ranged from 10.8 to 14.5 out of 18 points. Fear or mistrust of surgical care and stigma were reported more frequently in Nandom (p < .001). Reported barriers were not always the same in each community. Systematically defining barriers to essential surgical care provides an opportunity for planning targeted interventions at the community-level.