Association of Health Care Use and Economic Outcomes After Injury in Cameroon
Authors: S. Ariane Christie, Drusia Dickson, Susana N. Mbeboh, Frida N. Embolo, William Chendjou, Emerson Wepngong, Ahmed N. Fonje, Eunice Oben, Kareen Azemfac, Alain Chichom Mefire, Theophile Nana, M. Agbor Mbianyor, Patrick Stern, Rochelle Dicker, Catherine Juillard
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Despite the highest injury rates worldwide, formal medical care is not often sought after injuries in Sub-Saharan Africa. Unaffordable costs associated with trauma care might inhibit injured patients from seeking care. <h3>Objectives</h3> To (1) determine the injury epidemiology in Cameroon using population-representative data, (2) identify the barriers to use of formal health care after injury, and (3) determine the association between use of care and economic outcomes after injury. <h3>Design, Setting, and Participants</h3> This mixed-methods, cross-sectional study included a population-representative, community-based survey and nested qualitative semistructured interviews in the urban-rural Southwest Region of Cameroon. Three-stage cluster sampling was used to select target households. Data were collected from January 3 to March 14, 2017, and analyzed from March 3, 2017, to March 3, 2019. <h3>Exposures</h3> Injuries occurring in the preceding 12 months. <h3>Main Outcomes and Measures</h3> Postinjury use of health care services, disability, and economic outcomes. All survey data were adjusted for cluster sampling. <h3>Results</h3> Of 1551 total households approached, 1287 (83.0%) were surveyed for a total sample size of 8065 participants. The 8065 individuals surveyed included 4181 women (52.0%), with a mean age of 23.9 (standard error [SE], 0.2) years. A total of 503 injuries were identified among 471 unique participants, including 494 nonfatal injuries. Among these, 165 (34.6%) did not seek formal medical services. Disability occurred after 345 injuries (68.6%) and resulted in 11 941 lost days of work in the sample. Family economic hardship after injury was substantially increased among the injured cohort who used formal medical care. Injuries brought to formal medical care, compared with those that were note, incurred higher mean treatment costs ($101.08 [SE, $236.23] vs $12.13 [SE, $36.78];<i>P</i> &lt; .001), resulted in higher rates of lost employment (19.9% [SE, 3.6%] vs 5.6% [SE, 1.6%];<i>P</i> = .004), and more frequently led affected families to use economic coping strategies, such as borrowing money (26.2% [SE, 2.7%] vs 7.1% [SE, 1.2%];<i>P</i> &lt; .001). After adjusting for age and severity, use of formal medical care in Cameroon was independently associated with severe economic hardship after injury, defined as a new inability to afford food or rent (adjusted odds ratio, 1.67; 95% CI, 1.05-2.65). <h3>Conclusions and Relevance</h3> In this study, injury in Southwestern Cameroon was associated with significant disability and lost productivity. Formal medical treatment of injury was associated with significant financial consequences for households of injured patients. Primary prevention of road traffic injuries and financial restructuring of emergency care could improve trauma care access in Cameroon and reduce the societal effects of injury.