Abstract:
Gender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya’s health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya. Materials and Methods: All patients ≥13 years admitted to the general surgery service at Moi
General surgery Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records
Global surgery were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment,
Gender disparity and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson’s Chi-
Healthcare disparity square, and Fisher’s Exact tests. Low- and middle-income countries
Results: 366 patients were included for analysis. 48.6% were enrolled in NHIF with significant
female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male
and female patients underwent surgery and suffered in-hospital mortality at similar rates.However, women only comprised 39.6% of admissions and were significantly more likely to
delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus
13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P =
0.013). Conclusion: Many financial and cultural barriers exist in Kenya that prevent women from
accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.
