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Keating EM, Sakita F, Vlasic K, Amiri I, Nkini G, Nkoronko M, Young B, Birchall J, Watt MH, Staton CA, Mmbaga BT. Healthcare provider perspective on barriers and facilitators in the care of pediatric injury patients at a tertiary hospital in Northern Tanzania: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002599. [PMID: 37983210 PMCID: PMC10659160 DOI: 10.1371/journal.pgph.0002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). The recovery of injured children in LMICs is often impeded by barriers in accessing and receiving timely and quality care at healthcare facilities. The purpose of this study was to identify the barriers and the facilitators in pediatric injury care at Kilimanjaro Christian Medical Center (KCMC), a tertiary zonal referral hospital in Northern Tanzania. In this study, focus group discussions (FGDs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the barriers and facilitators in pediatric injury care. Five FGDs were completed from February 2021 to July 2021. Participants (n = 30) were healthcare providers from the emergency department, burn ward, surgical ward, and pediatric ward. De-identified transcripts were analyzed with team-based, applied thematic analysis using qualitative memo writing and consensus discussions. Our study found barriers that impeded pediatric injury care were: lack of pediatric-specific injury training and care guidelines, lack of appropriate pediatric-specific equipment, staffing shortages, lack of specialist care, and complexity of cases due to pre-hospital delays in patients presenting for care due to cultural and financial barriers. Facilitators that improved pediatric injury care were: team cooperation and commitment, strong priority and triage processes, benefits of a tertiary care facility, and flexibility of healthcare providers to provide specialized care if needed. The data highlights barriers and facilitators that could inform interventions to improve the care of pediatric injury patients in Northern Tanzania such as: increasing specialized provider training in pediatric injury management, the development of pediatric injury care guidelines, and improving access to pediatric-specific technologies and equipment.
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Affiliation(s)
- Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajsa Vlasic
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mugisha Nkoronko
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bryan Young
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Jenna Birchall
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya. Afr J Emerg Med 2022; 12:321-326. [PMID: 35892006 PMCID: PMC9307445 DOI: 10.1016/j.afjem.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/24/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Trauma is a leading cause of morbidity and mortality in Kenya. In many countries, substance use is common among patients presenting with injuries to an emergency center (EC). Objective To describe the epidemiology of self-reported substance use among adult injured patients seeking ED care in Nairobi, Kenya. Methods This prospective cross-sectional study, assessed patients presenting with injuries to the Kenyatta National Hospital ED in Nairobi, Kenya from March through June of 2021. Data on substance use, injury characteristics and ED disposition were collected. Substances of interest were alcohol, stimulants, marijuana, and opiates. The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) tool was used to characterize hazardous alcohol use. Results A total of 1,282 patients were screened for participation, of which 646 were enrolled. Among participants, 322 (49.8%) reported substance use in the past month (AUDIT-C positive, stimulants, opiates, and/or marijuana). Hazardous alcohol use was reported by 271 (42.0%) patients who screened positive with AUDIT-C. Polysubstance use, (≥2 substances) was reported by 87 participants in the past month. Median time from injury to ED arrival was 13.1 h for all enrolees, and this number was significantly higher among substance users (median 15.4 h, IQR 5.5 - 25.5; p = 0.029). Conclusions In the population studied, reported substance use was common with a substantial proportion of injured persons screening positive for hazardous alcohol use. Those with substance use had later presentations for injury care. These data suggest that ED programming for substance use disorder screening and care linkage could be impactful in the study setting.
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Barcenas LK, Appenteng R, Sakita F, O’Leary P, Rice H, Mmbaga BT, Vissoci JRN, Staton CA. The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania. PLoS One 2022; 17:e0273991. [PMID: 36197935 PMCID: PMC9534435 DOI: 10.1371/journal.pone.0273991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background Over 95% of childhood injury deaths occur in low- and middle-income countries (LMICs). Patients with severe traumatic brain injury (TBI) have twice the likelihood of dying in LMICs than in high-income countries (HICs). In Africa, TBI estimates are projected to increase to upwards of 14 million new cases in 2050; however, these estimates are based on sparse data, which underscores the need for robust injury surveillance systems. We aim to describe the clinical factors associated with morbidity and mortality in pediatric TBI at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania to guide future prevention efforts. Methods We conducted a secondary analysis of a TBI registry of all pediatric (0–18 years of age) TBI patients presenting to the KCMC emergency department (ED) between May 2013 and April 2014. The variables included demographics, acute treatment and diagnostics, Glasgow Coma Scores (GCSs, severe 3–8, moderate 9–13, and mild 14–15), morbidity at discharge as measured by the Glasgow Outcome Scale (GOS, worse functional status 1–3, better functional status 4–6), and mortality status at discharge. The analysis included descriptive statistics, bivariable analysis and multivariable logistic regression to report the predictors of mortality and morbidity. The variables used in the multivariable logistic regression were selected according to their clinical validity in predicting outcomes. Results Of the total 419 pediatric TBI patients, 286 (69.3%) were male with an average age of 10.12 years (SD = 5.7). Road traffic injury (RTI) accounted for most TBIs (269, 64.4%), followed by falls (82, 19.62%). Of the 23 patients (5.58%) who had alcohol-involved injuries, most were male (3.6:1). Severe TBI occurred in 54 (13.0%) patients. In total, 90 (24.9%) patients underwent TBI surgery. Of the 21 (5.8%) patients who died, 11 (55.0%) had severe TBI, 6 (30.0%) had moderate TBI (GCS 9–13) and 3 (15.0%) presented with mild TBI (GCS>13). The variables most strongly associated with worse functional status included having severe TBI (OR = 9.45) and waiting on the surgery floor before being moved to the intensive care unit (ICU) (OR = 14.37). Conclusions Most pediatric TBI patients were males who suffered RTIs or falls. Even among children under 18 years of age, alcohol was consumed by at least 5% of patients who suffered injuries, and more commonly among boys. Patients becoming unstable and having to be transferred from the surgery floor to the ICU could reflect poor risk identification in the ED or progression of injury severity. The next steps include designing interventions to reduce RTI, mitigate irresponsible alcohol use, and improve risk identification and stratification in the ED.
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Affiliation(s)
| | | | | | - Paige O’Leary
- Duke Global Health Institute, Durham, NC, United States of America
| | - Henry Rice
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, United States of America
- Vanderbilt University, Nashville, TN, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Catherine A. Staton
- Duke Global Health Institute, Durham, NC, United States of America
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- * E-mail:
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Manning Smith R, Cambiano V, Colbourn T, Collins JH, Graham M, Jewell B, Li Lin I, Mangal TD, Manthalu G, Mfutso-Bengo J, Mnjowe E, Mohan S, Ng'ambi W, Phillips AN, Revill P, She B, Sundet M, Tamuri A, Twea PD, Hallet TB. Estimating the health burden of road traffic injuries in Malawi using an individual-based model. Inj Epidemiol 2022; 9:21. [PMID: 35821170 PMCID: PMC9275162 DOI: 10.1186/s40621-022-00386-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to determine. A limited number of models predict the incidence of mortality due to road traffic injury in Malawi. These estimates vary greatly, owing to differences in assumptions, and so the health burden caused on the population by road traffic injuries remains unclear. METHODS We use an individual-based model and combine an epidemiological model of road traffic injuries with a health seeking behaviour and health system model. We provide a detailed representation of road traffic injuries in Malawi, from the onset of the injury through to the final health outcome. We also investigate the effects of an assumption made by other models that multiple injuries do not contribute to health burden caused by road accidents. RESULTS Our model estimates an overall average incidence of mortality between 23.5 and 29.8 per 100,000 person years due to road traffic injuries and an average of 180,000 to 225,000 disability-adjusted life years (DALYs) per year between 2010 and 2020 in an estimated average population size of 1,364,000 over the 10-year period. Our estimated incidence of mortality falls within the range of other estimates currently available for Malawi, whereas our estimated number of DALYs is greater than the only other estimate available for Malawi, the GBD estimate predicting and average of 126,200 DALYs per year over the same time period. Our estimates, which account for multiple injuries, predict a 22-58% increase in overall health burden compared to the model ran as a single injury model. CONCLUSIONS Road traffic injuries are difficult to model with conventional modelling methods, owing to the numerous types of injuries that occur. Using an individual-based model framework, we can provide a detailed representation of road traffic injuries. Our results indicate a higher health burden caused by road traffic injuries than previously estimated.
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Affiliation(s)
| | | | - Tim Colbourn
- University College London, Gower Street, London, WC1E 6BT, UK
| | | | - Matthew Graham
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Britta Jewell
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Ines Li Lin
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Tara D Mangal
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Gerald Manthalu
- Ministry of Health and Population, P.O. Box 30377, Lilongwe 3, Malawi
| | - Joseph Mfutso-Bengo
- Kamuzu University of Health Sciences, Mahatma Gandhi, 52X8+782, Blantyre, Malawi
| | | | | | | | | | | | - Bingling She
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Mads Sundet
- REMEDY-Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Asif Tamuri
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Pakwanja D Twea
- Ministry of Health and Population, P.O. Box 30377, Lilongwe 3, Malawi
| | - Timothy B Hallet
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Lee JA, Armes L, Wachira BW. Using social media in Kenya to quantify road safety: an analysis of novel data. Int J Emerg Med 2022; 15:30. [PMID: 35764949 PMCID: PMC9238258 DOI: 10.1186/s12245-022-00432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries are a large and growing cause of morbidity and mortality in low- and middle-income countries, especially in Africa. Systematic data collection for traffic incidents in Kenya is lacking and in many low- and middle-income countries available data sources are disparate or missing altogether. Many Kenyans use social media platforms, including Twitter; many road traffic incidents are publicly reported on the microblog platform. This study is a prospective cohort analysis of all tweets related to road traffic incidents in Kenya over a 24-month period (February 2019 to January 2021). RESULTS A substantial number of unique road incidents (3882) from across Kenya were recorded during the 24-month study period. The details available for each incident are widely variable, as reported and posted on Twitter. Particular times of day and days of the week had a higher incidence of reported road traffic incidents. A total of 2043 injuries and 1503 fatalities were recorded. CONCLUSIONS Twitter and other digital social media platforms can provide a novel source for road traffic incident and injury data in a low- and middle-income country. The data collected allows for the potential identification of local and national trends and provides opportunities to advocate for improved roadways and health systems for the emergent care from road traffic incidents and associated traumatic injuries.
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Affiliation(s)
- J Austin Lee
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA.
| | - Lyndsey Armes
- School of Public Health, Brown University, Providence, RI, USA
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Larson PS, Eisenberg JNS, Berrocal VJ, Mathanga DP, Wilson ML. An urban-to-rural continuum of malaria risk: new analytic approaches characterize patterns in Malawi. Malar J 2021; 20:418. [PMID: 34689786 PMCID: PMC8543962 DOI: 10.1186/s12936-021-03950-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The urban-rural designation has been an important risk factor in infectious disease epidemiology. Many studies rely on a politically determined dichotomization of rural versus urban spaces, which fails to capture the complex mosaic of infrastructural, social and environmental factors driving risk. Such evaluation is especially important for Plasmodium transmission and malaria disease. To improve targeting of anti-malarial interventions, a continuous composite measure of urbanicity using spatially-referenced data was developed to evaluate household-level malaria risk from a house-to-house survey of children in Malawi. METHODS Children from 7564 households from eight districts throughout Malawi were tested for presence of Plasmodium parasites through finger-prick blood sampling and slide microscopy. A survey questionnaire was administered and latitude and longitude coordinates were recorded for each household. Distances from households to features associated with high and low levels of development (health facilities, roads, rivers, lakes) and population density were used to produce a principal component analysis (PCA)-based composite measure for all centroid locations of a fine geo-spatial grid covering Malawi. Regression methods were used to test associations of the urbanicity measure against Plasmodium infection status and to predict parasitaemia risk for all locations in Malawi. RESULTS Infection probability declined with increasing urbanicity. The new urbanicity metric was more predictive than either a governmentally defined rural/urban dichotomous variable or a population density variable. One reason for this was that 23% of cells within politically defined rural areas exhibited lower risk, more like those normally associated with "urban" locations. CONCLUSIONS In addition to increasing predictive power, the new continuous urbanicity metric provided a clearer mechanistic understanding than the dichotomous urban/rural designations. Such designations often ignore urban-like, low-risk pockets within traditionally rural areas, as were found in Malawi, along with rural-like, potentially high-risk environments within urban areas. This method of characterizing urbanicity can be applied to other infectious disease processes in rapidly urbanizing contexts.
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Affiliation(s)
- Peter S Larson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Joseph N S Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Veronica J Berrocal
- Department of Statistics, School of Information and Computer Sciences, University of California, Irvine, CA, 92697, USA
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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Gillio AM, Li HW, Bhatia MB, Chepkemoi E, Rutto EJ, Carpenter KL, Saruni SI, Keung CH, Hunter-Squires JL. Gender Differences in Insurance, Surgical Admissions and Outcomes at a Kenyan Referral Hospital. J Surg Res 2021; 268:199-208. [PMID: 34340011 DOI: 10.1016/j.jss.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION 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 National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, 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 Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests. 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.
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Affiliation(s)
- Anna M Gillio
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND.
| | - Helen W Li
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - Manisha B Bhatia
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | | | | | - Kyle L Carpenter
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - Seno I Saruni
- Moi Teaching and Referral Hospital, Kesses, Eldoret, Kenya
| | - Connie H Keung
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - JoAnna L Hunter-Squires
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND; Moi University, Kesses, Eldoret, Kenya
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Yang L, Slate-Romano J, Marqués CG, Uwamahoro C, Twagirumukiza FR, Naganathan S, Moretti K, Jing L, Levine AC, Stephen A, Aluisio AR. Evaluation of blood product transfusion therapies in acute injury care in low- and middle-income countries: a systematic review. Injury 2020; 51:1468-1476. [PMID: 32409189 DOI: 10.1016/j.injury.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries. METHODS A systematic search of PubMed, EMBASE, Global Health, CINAHL and Cochrane databases through November 2018 was performed by a health sciences medical librarian. Prospective and cross-sectional reports of injured patients from LMICs involving data on blood product transfusion therapies were included. Two reviewers identified eligible records (κ=0.92); quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Report elements, patient characteristics, injury information, blood transfusion therapies provided and mortality outcomes were extracted and analyzed. RESULTS Of 3411 records, 150 full-text reports were reviewed and 17 met inclusion criteria. Identified reports came from the World Health Organization regions of Africa, the Eastern Mediterranean, and South-East Asia. A total of 6535 patients were studied, with the majority from exclusively inpatient hospital settings (52.9%). Data on transfusion therapies demonstrated that packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%. The overall quality of evidence was either low (52.9%) or very low (41.2%), with one report of moderate quality by GRADE criteria. CONCLUSION There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.
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Affiliation(s)
- Lanbo Yang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Catalina González Marqués
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Sonya Naganathan
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Katelyn Moretti
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ling Jing
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam C Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Andrew Stephen
- Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA.
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Baru A, Weldegiorgis E, Zewdu T, Hussien H. Characteristics and outcome of traumatic chest injury patients visited a specialized hospital in Addis Ababa, Ethiopia: A one-year retrospective study. Chin J Traumatol 2020; 23:139-144. [PMID: 32111481 PMCID: PMC7296352 DOI: 10.1016/j.cjtee.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Injury continues to be an important cause of morbidity and mortality in both developed and developing countries. Globally, it is responsible for approximately 5.8 million deaths per year and 91% of these deaths occur in developing countries. Road traffic collision, suicides and homicides are the leading cause of traumatic deaths. Despite the fact that traumatic chest injury is being responsible for 10% of all trauma-related hospital admissions and 25% of trauma-related deaths across the world including in Ethiopia, only few published studies showed the burden of traumatic chest injury in Ethiopia. So, this study aims at assessing the characteristics and outcome of traumatic chest injury patients visited Tikur Anbesa Specialized Hospital (TASH) over one year period. METHODS A single center based retrospective study was done. We collected data from patients' records to assess characteristics and outcome of traumatic chest injury at TASH over one year period. All patients diagnosed with traumatic chest injury and received treatment at the hospital from January 1 to December 31, 2016 regardless of its types and severity levels were included in the study. Patients with incomplete medical records for at least 20% of the study variables and without detailed medical history, or patients died before receiving any health care were excluded from the study. The collected data were cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21.0 for analysis. Bivariate and multivariate logistic regression models were used to examine factors associated with outcome of traumatic chest injury patients. RESULTS A total of 192 chest injury patients were included in the study and about one-fourth of chest injury victims were died during treatment period in TASH. Road traffic collision (RTC) was the leading cause of morbidity and mortality among traumatic chest injury victims. Age of the victims (adjusted odds ratio (AOR) 8.9, 95% confidence interval (CI) 1.51-53.24), time elapsed between the occurrence of traumatic chest injury and admission to health care facilities (AOR 4.6, 95% CI 1.19-18.00), length of stay in hospital (AOR 0.12, 95% CI 0.02-0.58), presence of multiple extra-thoracic injury (AOR 25, 95% CI 4.18-150.02) and development of complications (AOR 23, 95% CI 10-550) were factors associated with death among traumatic chest injury patients in this study. CONCLUSION RTC contributed for a considerable number of traumatic chest injuries in this study. Old age, delay in delivering the victim to health care facilities, length of stay in hospital, and development of atelectasis and pneumonia were associated with death among traumatic chest injury patients. Road safety interventions, establishment of organized pre-hospital services, and early recognition and prompt management of traumatic chest injury related complications are urgently needed to overcome the underlying problems in the study setting.
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Affiliation(s)
- Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia.
| | | | - Tigist Zewdu
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heyria Hussien
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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10
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Feldhaus I, Carvalho M, Waiz G, Igu J, Matthay Z, Dicker R, Juillard C. Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review. Trauma Surg Acute Care Open 2020; 5:e000424. [PMID: 32420451 PMCID: PMC7223475 DOI: 10.1136/tsaco-2019-000424] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background About 5.8 million people die each year as a result of injuries, and nearly 90% of these deaths occur in low and middle-income countries (LMIC). Trauma scoring is a cornerstone of trauma quality improvement (QI) efforts, and is key to organizing and evaluating trauma services. The objective of this review was to assess the appropriateness, feasibility, and QI applicability of traditional trauma scoring systems in LMIC settings. Materials and methods This systematic review searched PubMed, Scopus, CINAHL, and trauma-focused journals for articles describing the use of a standardized trauma scoring system to characterize holistic health status. Studies conducted in high-income countries (HIC) or describing scores for isolated anatomic locations were excluded. Data reporting a score’s capacity to discriminate mortality, feasibility of implementation, or use for QI were extracted and synthesized. Results Of the 896 articles screened, 336 were included. Over half of studies (56%) reported Glasgow Coma Scale, followed by Injury Severity Score (ISS; 51%), Abbreviated Injury Scale (AIS; 24%), Revised Trauma Score (RTS; 19%), Trauma and Injury Severity Score (TRISS; 14%), and Kampala Trauma Score (7%). While ISS was overwhelmingly predictive of mortality, 12 articles reported limited feasibility of ISS and/or AIS. RTS consistently underestimated injury severity. Over a third of articles (37%) reporting TRISS assessmentsobserved mortality that was greater than that predicted by TRISS. Several articles cited limited human resources as the key challenge to feasibility. Conclusions The findings of this review reveal that implementing systems designed for HICs may not be relevant to the burden and resources available in LMICs. Adaptations or alternative scoring systems may be more effective. PROSPERO registration number CRD42017064600.
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Affiliation(s)
- Isabelle Feldhaus
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Melissa Carvalho
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Ghazel Waiz
- Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
| | - Joel Igu
- Johns Hopkins University Carey Business School, Baltimore, Maryland, USA
| | - Zachary Matthay
- Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
| | - Rochelle Dicker
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Lampi M, Junker JPE, Tabu JS, Berggren P, Jonson CO, Wladis A. Potential benefits of triage for the trauma patient in a Kenyan emergency department. BMC Emerg Med 2018; 18:49. [PMID: 30497397 PMCID: PMC6267912 DOI: 10.1186/s12873-018-0200-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country. METHODS A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician's assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records. RESULTS A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories. CONCLUSION The results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.
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Affiliation(s)
- Maria Lampi
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johan P. E. Junker
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - John S. Tabu
- Department of Disaster Risk Management, Moi University College of Health and Science, Eldoret, Kenya
| | - Peter Berggren
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Wladis
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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12
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Kanyi JK, Ogada TV, Oloo MJ, Parker RK. Burr-Hole Craniostomy for Chronic Subdural Hematomas by General Surgeons in Rural Kenya. World J Surg 2018; 42:40-45. [PMID: 28741193 DOI: 10.1007/s00268-017-4143-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic subdural hematoma (cSDH) is a common condition that causes significant morbidity and mortality. In rural sub-Saharan Africa, there are very few neurosurgeons. Yet, cSDH is treatable by relatively simple surgical intervention with potential for rapid clinical improvement. METHODS We conducted a retrospective chart review of all patients with cSDH who underwent burr-hole trephination at Tenwek Hospital, Kenya, between July 2014 and July 2016. We extracted and compared the clinical presentation, risk factors, operative details, and outcomes. RESULTS A total of 119 patients were identified with a mean age of 61.3 years. The majority were men (80%). The main predisposing factors were trauma (54.6%) and alcohol intake (34.4%). Patients were generally managed with two burr-holes, irrigation, and a subdural drain, remaining for a median of 2 days. Operations were assisted by general surgery residents under direct supervision of senior residents (46), general surgeons (65), and neurosurgeons (8). Complications included recurrence (5.2%), subdural empyema (2.5%), postoperative seizures (3.4%), and mortality (6.7%). Improvement of symptoms was noted in 91% of all patients. CONCLUSION Operative management of cSDH can be safely performed in rural facilities by general surgeons familiar with the procedure and with the institutional resources. The majority of patients had satisfactory outcomes.
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Affiliation(s)
- John K Kanyi
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
| | - Timothy V Ogada
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
| | - Mark J Oloo
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya. .,Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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13
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Kiragu AW, Dunlop SJ, Mwarumba N, Gidado S, Adesina A, Mwachiro M, Gbadero DA, Slusher TM. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions. Front Pediatr 2018; 6:155. [PMID: 29915778 PMCID: PMC5994692 DOI: 10.3389/fped.2018.00155] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3-6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W. Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Stephen J. Dunlop
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Njoki Mwarumba
- Department of Political Science, Oklahoma State University, Stillwater, OK, United States
| | - Sanusi Gidado
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Adesope Adesina
- Department of Surgery, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | | | - Daniel A. Gbadero
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | - Tina M. Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
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Mowafi H, Oranmore-Brown R, Hopkins KL, White EE, Mulla YF, Seidenberg P. Analysis of Prehospital Transport Use for Trauma Patients in Lusaka, Zambia. World J Surg 2017; 40:2868-2874. [PMID: 27405748 DOI: 10.1007/s00268-016-3629-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite an increasing burden of injuries, prehospital transport systems remain underdeveloped in many low- and middle-income countries. Little information exists on the use of prehospital services for trauma patients in Zambia. METHOD A prospective, observational study of trauma presentations was undertaken for 6 months in Lusaka, Zambia, to establish the epidemiology and outcomes of injury in the region. In addition to demographics and mechanism of injury, data were collected on prehospital transport as well as inpatient resources utilization. Trained study personnel gathered data on trauma presentations 24 h a day. Statistical analysis was conducted using SAS 9.3 from a Microsoft® Access database. RESULTS 3498 trauma patients were enrolled in the study on arrival to University Teaching Hospital (UTH). 3264 patients had a transport means recorded (95.3 %). Two-thirds (66 %) arrived within 6 h of injury, and 23 % arrived within the first hour after injury. A majority arrived by private vehicle (53.4 %) or public transport (37.7 %); only 5.9 % were transported by public or private ambulance. Of those arriving within the first hour after injury, 69.1 % came by private car, 24.6 % by public transport and 3.1 % by ambulance. There was a small statistical increase in Kampala Trauma Score II among ambulance arrivals. CONCLUSION Trauma patient use a variety of transport methods to get to UTH. A majority of patients use no formal ambulance transport. Despite this fact, a majority arrives within 6 h of injury but receive no formal prehospital care. An integrated, multilayered prehospital care and transport system may be the most effective approach for Zambia.
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Affiliation(s)
- Hani Mowafi
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT, 06510, USA.
| | | | - Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Yacob F Mulla
- University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | - Phil Seidenberg
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
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15
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Vissoci JRN, Shogilev DJ, Krebs E, de Andrade L, Vieira IF, Toomey N, Batilana AP, Haglund M, Staton CA. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. TRAFFIC INJURY PREVENTION 2017; 18:767-773. [PMID: 28448753 PMCID: PMC6350910 DOI: 10.1080/15389588.2017.1314470] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate, through a systematic review of hospital-based studies, the proportion of road traffic injuries and fatalities in sub-Saharan Africa (SSA). METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology guidelines, we searched the following electronic databases: PubMed, Embase, Africa-Wide Information, Global Health, and Web of Science. Articles were eligible if they measured proportion of road traffic injuries (RTIs) in SSA by using hospital-based studies. In addition, a reference and citation analysis was conducted as well as a data quality assessment. RESULTS Up to 2015, there were a total of 83 hospital-based epidemiologic studies, including 310,660 trauma patients and 99,751 RTI cases, in 13 SSA countries. The median proportion of RTIs among trauma patients was 32% (4 to 91%), of which the median proportion of death for the included articles was 5% (0.3 to 41%). CONCLUSION The number of studies evaluating RTI proportions and fatalities in SSA countries is increasing but without the exponential rise expected from World Health Organization calls for research during the Decade of Action for Road Traffic Injuries. Further research infrastructure including standardization of taxonomy, definitions, and data reporting measures, as well as funding, would allow for improved cross-country comparisons.
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Affiliation(s)
- João Ricardo N. Vissoci
- Division of Emergency Medicine, Department of Surgery, Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham USA,
| | | | | | | | | | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, USA,
| | | | - Michael Haglund
- Duke School of Medicine, Duke Global Health Institute, Duke University, Durham USA,
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16
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Botchey IM, Hung YW, Bachani AM, Saidi H, Paruk F, Hyder AA. Understanding patterns of injury in Kenya: Analysis of a trauma registry data from a National Referral Hospital. Surgery 2017; 162:S54-S62. [PMID: 28438334 DOI: 10.1016/j.surg.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Injuries contribute to a substantial proportion of the burden of disease in Kenya. Trauma registries can be a very useful source of data to understand patterns of injuries and serve to provide information about potential improvements in the care of injured patients. In Kenya, health facility-based injury data has been largely administrative. Our aim was to develop and implement a prospective trauma registry at the largest trauma hospital in Kenya, the Kenyatta National Hospital, and to understand the nature of injuries presenting to the hospital, their treatment and care, and their outcomes. METHODS An electronic, tablet-based instrument was developed and implemented between January 2014 and June 2015. Data were collected at the emergency department, and patients were followed through disposition from the emergency department or in-patient wards if admitted. Variables included demographics, type of prehospital care received, details of the injury, and initial assessment and disposition from the emergency department or in-patient wards. Bivariate and multiple logistic regressions were used to assess potential risk factors associated with outcomes. RESULTS A total of 8,701 injury patients were included in the registry during the study period. The mean age of the injured patients was 28 years (standard deviation, 26 years). The majority of these patients were males (81.7%). The leading mechanisms of injuries were road traffic injury (41.7%), assault (25.3%), and falls (18.9%). Only 7.4% of patients received prehospital care; 49.6% of injured patients arrived within 1 hour after their injury. Hospital mortality was 4.4% and close to 1% of patients died in the emergency department. The independent predictors of in-hospital death were older age (≥60 years), injury mechanism (burns and road traffic injuries), and admission type (transfer) after controlling for injury severity. CONCLUSION The establishment of hospital-based trauma registries can be an important tool for injury surveillance. This information will facilitate identifying priority areas for trauma care and quality improvement, as well as guiding the development of injury prevention and control programs.
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Affiliation(s)
- Isaac M Botchey
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yuen Wai Hung
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hassan Saidi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Fatima Paruk
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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17
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Botchey IM, Hung YW, Bachani AM, Paruk F, Mehmood A, Saidi H, Hyder AA. Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study. Surgery 2017; 162:S45-S53. [PMID: 28385178 DOI: 10.1016/j.surg.2017.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low- and middle-income countries where more than 90% of injury-related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low- and middle-income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital-based trauma registries. METHODS From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes. RESULTS A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale ≤12, estimated injury severity score ≥9, burns, and gunshot injuries. CONCLUSION Hospital-based trauma registries can be important sources of data to study the epidemiology of injuries in low- and middle-income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality-of-care improvement programs.
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Affiliation(s)
- Isaac M Botchey
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yuen W Hung
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Fatima Paruk
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amber Mehmood
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hassan Saidi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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18
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Gathecha GK, Githinji WM, Maina AK. Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January-June 2014. BMC Public Health 2017; 17:34. [PMID: 28056893 PMCID: PMC5217327 DOI: 10.1186/s12889-016-3958-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022] Open
Abstract
Background Violence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. Approximately five million people die from injuries each year, accounting 9% of all deaths worldwide. In Kenya, injuries are increasingly becoming a cause of hospital admissions and mortality where they account for 10% of all the deaths. The objective of this study was to determine the magnitude, demographic profile and pattern of fatal injuries in Nairobi. Methods Retrospective review of death certificates from the Department of Civil Registration was done for deaths caused by injuries that occurred in Nairobi during the period, January to June 2014. Data was collected using a standardized form. Data entry, cleaning and analysis was done using Epi info version 7.0. Results A total of 11,443 records were reviewed. From this data, deaths resulting from injuries were 1,208 accounting for 10.6% of all recorded deaths. Majority of the deaths resulting from injuries occurred in persons aged 25 to 44 years (48.1%). Males accounted for 85% of all the injuries. The leading cause of injury was assault by blunt force at 30.5%, followed by road traffic injuries at 25.9% and fire arm injuries at 15%. Pre-hospital deaths accounted for 51.4% of all the deaths. Nineteen percent of the deaths resulting from injuries had autopsies performed on them. Conclusion Our study found that injuries are an important cause of fatality in Nairobi, accounting for one in ten deaths. There is need for multisectoral collaboration as some of the preventive measures that target the most prevalent injuries such as assault and road traffic injuries lie outside the health sector. There exists information gaps on the death certificates hence there is need to adequately capacity build both clinicians and death certifiers. There is also a need to revise the death certificates and to improve the pre-hospital care system for the injured persons. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3958-0) contains supplementary material, which is available to authorized users.
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Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad H, Abolghasem Gorji H. Injury epidemiology in Iran: a systematic review. J Inj Violence Res 2017; 9:852. [PMID: 28039683 PMCID: PMC5279990 DOI: 10.5249/jivr.v9i1.852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the epidemiology of injuries in Iran through a systematic review. Methods: Required data were collected searching the following key words and their Persian equivalents; trauma, injury, accident, epidemiology, prevalence, pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts. Results: Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. The males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%) followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents. Conclusions: The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).
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Affiliation(s)
| | | | | | - Hassan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Wu HH, Patel KR, Caldwell AM, Coughlin RR, Hansen SL, Carey JN. Surgical Management and Reconstruction Training (SMART) Course for
International Orthopedic Surgeons. Ann Glob Health 2016; 82:652-658. [DOI: 10.1016/j.aogh.2016.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kearney AS, Kabeja LM, George N, Karim N, Aluisio AR, Mutabazi Z, Uwitonze JE, Nyinawankusi JD, Byiringiro JC, Levine AC. Development of a trauma and emergency database in Kigali, Rwanda. Afr J Emerg Med 2016; 6:185-190. [PMID: 30456093 PMCID: PMC6234174 DOI: 10.1016/j.afjem.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/26/2016] [Accepted: 10/04/2016] [Indexed: 01/21/2023] Open
Abstract
Introduction Injuries account for 10% of the global burden of disease, resulting in approximately 5.8 million deaths annually. Trauma registries are an important tool in the development of a trauma system; however, limited resources in low- and middle-income countries (LMIC) make the development of high-quality trauma registries challenging. We describe the development of a LMIC trauma registry based on a robust retrospective chart review, which included data derived from prehospital, emergency centre and inpatient records. Methods This paper outlines our methods for identifying and locating patients and their medical records using pragmatic and locally appropriate record linkage techniques. A prehospital database was queried to identify patients transported to University Teaching Hospital – Kigali, Rwanda from December 2012 through February 2015. Demographic information was recorded and used to create a five-factor identification index, which was then used to search OpenClinic GA, an online open source hospital information system. The medical record number and archive number obtained from OpenClinic GA were then used to locate the physical medical record for data extraction. Results A total of 1668 trauma patients were transported during the study period. 66.7% were successfully linked to their medical record numbers and archive codes. 94% of these patients were successfully linked to their medical record numbers and archive codes were linked by four or five of the five pre-set identifiers. 945 charts were successfully located and extracted for inclusion in the trauma registry. Record linkage and chart extraction took approximately 1256 h. Conclusion The process of record linkage and chart extraction was a resource-intensive process; however, our unique methodology resulted in a high linkage rate. This study suggests that it is feasible to create a retrospective trauma registry in LMICs using pragmatic and locally appropriate record linkage techniques.
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Epidemiology of injuries and outcomes among trauma patients receiving prehospital care at a tertiary teaching hospital in Kigali, Rwanda. Afr J Emerg Med 2016; 6:191-197. [PMID: 30456094 PMCID: PMC6234177 DOI: 10.1016/j.afjem.2016.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Injury accounts for 9.6% of the global mortality burden, disproportionately affecting those living in low- and middle-income countries. In an effort to improve trauma care in Rwanda, the Ministry of Health developed a prehospital service, Service d’Aide Médicale Urgente (SAMU), and established an emergency medicine training program. However, little is known about patients receiving prehospital and emergency trauma care or their outcomes. The objective was to develop a linked prehospital–hospital database to evaluate patient characteristics, mechanisms of injury, prehospital and hospital resource use, and outcomes among injured patients receiving acute care in Kigali, Rwanda. Methods A retrospective cohort study was conducted at University Teaching Hospital – Kigali, the primary trauma centre in Rwanda. Data was included on all injured patients transported by SAMU from December 2012 to February 2015. SAMU’s prehospital database was linked to hospital records and data were collected using standardised protocols by trained abstractors. Demographic information, injury characteristics, acute care, hospital course and outcomes were included. Results 1668 patients were transported for traumatic injury during the study period. The majority (77.7%) of patients were male. The median age was 30 years. Motor vehicle collisions accounted for 75.0% of encounters of which 61.4% involved motorcycles. 48.8% of patients sustained injuries in two or more anatomical regions. 40.1% of patients were admitted to the hospital and 78.1% required surgery. The overall mortality rate was 5.5% with nearly half of hospital deaths occurring in the emergency centre. Conclusion A linked prehospital and hospital database provided critical epidemiological information describing trauma patients in a low-resource setting. Blunt trauma from motor vehicle collisions involving young males constituted the majority of traumatic injury. Among this cohort, hospital resource utilisation was high as was mortality. This data can help guide the implementation of interventions to improve trauma care in the Rwandan setting.
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Assessment of Survival and Hospital Care Quality in Patients with Traffic Injury in East Azerbaijan. Trauma Mon 2016. [DOI: 10.5812/traumamon.35303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kiragu AW, Dunlop SJ, Wachira BW, Saruni SI, Mwachiro M, Slusher T. Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward. J Pediatr Intensive Care 2016; 6:52-59. [PMID: 31073425 DOI: 10.1055/s-0036-1584676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W Kiragu
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Medicine, University of Minnesota, Minneapolis, Minnesota, United States
| | - Benjamin W Wachira
- Accident and Emergency Department, Aga Khan University Hospital, Nairobi, Kenya
| | - Seno I Saruni
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Tina Slusher
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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Associations with Perioperative Mortality Rate at a Major Referral Hospital in Rwanda. World J Surg 2015; 40:784-90. [DOI: 10.1007/s00268-015-3308-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Orthopaedic injuries from trauma are increasingly common in Low to Middle Income Countries secondary to the increase in road traffic. These injuries commonly contain a soft tissue component, which complicates treatment of bony injuries and increases amputation rate. Specialized care using plastic surgery techniques is required to effectively treat these injuries. Historically medical mission models have been used to provide specialists to help provide soft tissue coverage where plastic surgeons are not available. This type of care is inherently unsustainable. We present an approach where a course was designed to teach soft tissue coverage techniques to orthopaedic surgeons. The course was given annually over 5 years, serving approximately 300 participants. Data collected from participants demonstrated that they found the course useful, learned techniques that allowed them to care for patients, and disseminate the knowledge further. Participants endorsed that they had performed 594 flaps with a 93% success rate at 1 year of follow-up from the course. We find that this type of intervention has the potential to address the need for soft tissue coverage in countries where this need is present, and resources are unavailable.
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Bhatti JA, Farooq U, Majeed M, Khan JS, Razzak JA, Khan MM. Fall-related injuries in a low-income setting: Results from a pilot injury surveillance system in Rawalpindi, Pakistan. J Epidemiol Glob Health 2015; 5:283-90. [PMID: 25725473 PMCID: PMC7320534 DOI: 10.1016/j.jegh.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 12/01/2022] Open
Abstract
This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments (EDs) of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% (N = 27,109) were due to falls. Children (0–15 years) accounted for about two out of five of all fall-related injuries. Compared with women aged 16–45 years, more men of the same age group presented with fall-related injuries (50% vs. 42%); however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries (16% vs. 9%, P < 0.001). For each reported death due to falls (n = 57), 43 more were admitted (n = 2443, 9%), and another 423 were discharged from the EDs (n = 24,142, 91%). Factors associated with death or inpatient admission were: aged 0–15 years (adjusted odds ratio [aOR] = 1.35), aged 45 years or more (aOR = 1.94), male gender (aOR = 1.15), falls occurring at home (aOR = 3.38), in markets (aOR = 1.43), on work sites (aOR = 4.80), and during playing activities (aOR = 1.68). This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites.
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Affiliation(s)
- Junaid A Bhatti
- Sunnybrook Health Sciences Centre Research Institute, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Umar Farooq
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Mudassir Majeed
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Jahangir S Khan
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Junaid A Razzak
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Muhammad M Khan
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
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The burden of trauma in four rural district hospitals in Malawi: a retrospective review of medical records. Injury 2014; 45:2065-70. [PMID: 25458068 DOI: 10.1016/j.injury.2014.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/05/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few injury surveillance systems collect data in sub-Saharan Africa. This medical record review of four rural hospitals provides baseline data on the burden of trauma in Malawi. METHODS We reviewed all outpatient, inpatient, and mortuary records for one full year at four of the 28 district hospitals in Malawi: Dedza in central Malawi, Mangochi in the east, Nkhata Bay in the north, and Thyolo in the south. We used descriptive and comparative statistics to examine characteristics of patients and the data file. RESULTS During 2012, 18,735 trauma patients were treated at the four district hospitals. Trauma cases accounted for 3.5% of the 541,170 patient visits. In total, 60.8% of trauma patients were male; 39.1% were 0–14 years old and 50.4% were 15–49 years old. The logbooks were missing information about the primary type of injury for 44.9% of patients and about injury cause for 82.7%. Of the recorded trauma diagnoses, the most common injuries were soft tissue injuries, fractures, and sprains. The most commonly reported causes of injuries were animal bites (mostly dog bites), road traffic injuries, assaults, burns, and falls. CONCLUSIONS The development and implementation of improved methods for acquiring more complete, accurate, and useful trauma data in Malawi and other low-income countries requires addressing difficulties that might result in missing data. Increased injury surveillance is critical for improving trauma care and meeting the emerging global demand for burden of disease data.
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Maier D, Njoku I, Schmutzhard E, Dharsee J, Doppler M, Härtl R, Winkler AS. Traumatic Brain Injury in a Rural and an Urban Tanzanian Hospital—A Comparative, Retrospective Analysis Based on Computed Tomography. World Neurosurg 2014; 81:478-82. [DOI: 10.1016/j.wneu.2013.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022]
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Clarke DL, Aldous C, Thomson SR. Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning? Eur J Trauma Emerg Surg 2014; 40:303-8. [PMID: 26816064 DOI: 10.1007/s00068-013-0369-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/29/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. METHODS Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. RESULTS The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. CONCLUSION There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and deliver all acute trauma patients to large regional trauma centers. If the first option is chosen, urgent intervention is required to build up the human resource capacity of district hospitals.
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Affiliation(s)
- D L Clarke
- Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - C Aldous
- Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - S R Thomson
- Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa.,Division of Gastroenterology, E23 GI Unit, Groote Schuur Hospital, University of Cape Town, Room 93, New Main Building, Observatory, Cape Town, 7925, South Africa
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Chalya PL, Dass RM, Mchembe MD, Mbelenge N, Ngayomela IH, Chandika AB, Gilyoma JM, Mabula JB. Citywide trauma experience in Mwanza, Tanzania: a need for urgent intervention. J Trauma Manag Outcomes 2013; 7:9. [PMID: 24499566 PMCID: PMC4028861 DOI: 10.1186/1752-2897-7-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 11/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. METHODS A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. RESULTS A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). CONCLUSION Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Ramesh M Dass
- Department of Orthopaedic & Traumatology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Mabula D Mchembe
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Nkinda Mbelenge
- Department of Orthopaedic & Traumatology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Isdori H Ngayomela
- Department of Orthopaedic & Traumatology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Alphonce B Chandika
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Japhet M Gilyoma
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
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Trauma-related mortality among adults in Rural Western Kenya: characterising deaths using data from a health and demographic surveillance system. PLoS One 2013; 8:e79840. [PMID: 24244569 PMCID: PMC3820584 DOI: 10.1371/journal.pone.0079840] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/25/2013] [Indexed: 02/02/2023] Open
Abstract
Background Information on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS) were examined to characterise such deaths in rural western Kenya. Methods And Findings Verbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4%) were attributed to trauma; 71% of these were in males. Trauma contributed 17% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04) and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25%) and road traffic injuries (n=47, 15%); and falls for females (n=17, 13%). A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4) and assault (RR 1.8, 1.2-2.6) occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95% CI 1.7-9.4); risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2). Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8). Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9) compared with non-regular drinkers. Conclusions While trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.
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Matityahu A, Elliott I, Marmor M, Caldwell A, Coughlin R, Gosselin RA. Time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems. Bull World Health Organ 2013; 92:40-50. [PMID: 24391299 DOI: 10.2471/blt.13.120436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/08/2013] [Accepted: 08/23/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the use of time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems. METHODS Time intervals from injury to admission, admission to surgery and surgery to discharge for patients with isolated femur fractures in four low- and middle-income countries were compared with the corresponding values from one German hospital, an Israeli hospital and the National Trauma Data Bank of the United States of America by means of Student's t-tests. The correlations between the time intervals recorded in a country and that country's expenditure on health and gross domestic product (GDP) were also evaluated using Pearson's product moment correlation coefficient. FINDINGS Relative to patients from high-income countries, those from low- and middle-income countries were significantly more likely to be male and to have been treated by open femoral nailing, and their intervals from injury to admission, admission to surgery and surgery to discharge were significantly longer. Strong negative correlations were detected between the interval from injury to admission and government expenditure on health, and between the interval from admission to surgery and the per capita values for total expenditure on health, government expenditure on health and GDP. Strong positive correlations were detected between the interval from surgery to discharge and general government expenditure on health. CONCLUSION The time intervals for the treatment of femur fractures are relatively long in low- and middle-income countries, can easily be measured, and are highly correlated with accessible and quantifiable country data on health and economics.
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Affiliation(s)
- Amir Matityahu
- San Francisco General Hospital, University of California in San Francisco, 2550 Twenty-third Street, Building 9, 2nd Floor, San Francisco, CA 94110, United States of America (USA)
| | | | - Meir Marmor
- Orthopaedic Trauma Institute, University of California, San Francisco, USA
| | - Amber Caldwell
- Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, USA
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O'Reilly GM, Joshipura M, Cameron PA, Gruen R. Trauma registries in developing countries: a review of the published experience. Injury 2013; 44:713-21. [PMID: 23473265 DOI: 10.1016/j.injury.2013.02.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 12/26/2012] [Accepted: 02/02/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of injury is greatest in developing countries. Trauma systems have reduced mortality in developed countries and trauma registries are known to be integral to monitoring and improving trauma care. There are relatively few trauma registries in developing countries and no reviews describing the experience of each registry. The aim of this study was to examine the collective published experience of trauma registries in developing countries. METHODS A structured review of the literature was performed. Relevant abstracts were identified by searching databases for all articles regarding a trauma registry in a developing country. A tool was used to abstract trauma registry details, including processes of data collection and analysis. RESULTS There were 84 articles, 76 of which were sourced from 47 registries. The remaining eight articles were perspectives. Most were from Iran, followed by China, Jamaica, South Africa and Uganda. Only two registries used the Injury Severity Score (ISS) to define inclusion criteria. Most registries collected data on variables from all five variable groups (demographics, injury event, process of care, injury severity and outcome). Several registries collected data for less than a total of 20 variables. Only three registries measured disability using a score. The most commonly used scores of injury severity were the ISS, followed by Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and the Kampala Trauma Score (KTS). CONCLUSION Amongst the small number of trauma registries in developing countries, there is a large variation in processes. The implementation of trauma systems with trauma registries is feasible in under-resourced environments where they are desperately needed.
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Affiliation(s)
- Gerard M O'Reilly
- Victorian State Trauma Registry, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Road, Melbourne 3004, Australia.
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Abstract
BACKGROUND Little is known about the burden of surgical disease in rural sub-Saharan Africa, where district and rural hospitals are the main providers of care. The present study sought to analyze what is known about the met and unmet need of surgical disease. METHODS The PubMed and EMBASE databases were searched for studies of surveys in rural areas, information on surgical admissions, and operations performed within rural and district hospitals. Data were extrapolated to calculate the amount of surgical disease per 100,000 population and the number of operations performed per 100,000 population. These extrapolations were used to estimate the total, the met, and the unmet need of surgical disease. RESULTS The estimated overall incidence of nonfatal injury is at least 1,690/100,000 population per year. Morbidity as a result of injury is up to 190/100,000 population per year, and the annual mortality from injury is 53-92/100,000. District hospitals perform 6 fracture reductions (95% CI: 0.1-12)/100,000 population per year and 14 laparotomies (95% CI: 7-21)/100,000 per year. The incidence of peritonitis and bowel obstruction is unknown, although it may be as high as 1,364/100,000 population for the acute abdomen. The annual total need for inguinal hernia repair is estimated to be a minimum of 205/100,000 population. The average district hospital performs 30 hernia repairs (95% CI: 18-41)/100,000 population per year, leaving an unmet need of 175/100,000 population annually. CONCLUSIONS District hospitals are not meeting the surgical needs of the populations they serve. Urgent intervention is required to build up their capacity, to train healthcare personnel in safe surgery and anesthesia, and to overcome obstacles to timely emergency care.
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Ziraba AK, Kyobutungi C, Zulu EM. Fatal injuries in the slums of Nairobi and their risk factors: results from a matched case-control study. J Urban Health 2011; 88 Suppl 2:S256-65. [PMID: 21630106 PMCID: PMC3132230 DOI: 10.1007/s11524-011-9580-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.
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Affiliation(s)
- Abdhalah Kasiira Ziraba
- Faculty of Epidemiology and Population Health, Department of Population Studies, London School of Hygiene and Tropical Medicine, Room LG21, Keppel Street, London WC1E 7HT, UK.
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Adeleye AO, Okonkwo DO. Inter-hospital transfer for neurosurgical management of mild head injury in a developing country: A needless use of scarce resources? INDIAN JOURNAL OF NEUROTRAUMA 2011. [DOI: 10.1016/s0973-0508(11)80016-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lema MK, Chalya PL, Mabula JB, Mahalu W. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg 2011; 6:7. [PMID: 21244706 PMCID: PMC3033810 DOI: 10.1186/1749-8090-6-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. PATIENTS AND METHODS This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. RESULTS A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). CONCLUSION Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region.
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Affiliation(s)
- Monafisha K Lema
- Department of Surgery, Weill- Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Phillipo L Chalya
- Department of Surgery, Weill- Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Weill- Bugando University College of Health Sciences, Mwanza, Tanzania
| | - William Mahalu
- Department of Surgery, Weill- Bugando University College of Health Sciences, Mwanza, Tanzania
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Nsereko E, Brysiewicz P. Injury Surveillance in a Central Hospital in Kigali, Rwanda. J Emerg Nurs 2010; 36:212-6. [DOI: 10.1016/j.jen.2009.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/24/2009] [Accepted: 07/29/2009] [Indexed: 11/24/2022]
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Macleod JB, Gravelin S, Jones T, Gololov A, Thomas M, Omondi B, Bukusi E. Assessment of Acute Trauma Care Training in Kenya. Am Surg 2009. [DOI: 10.1177/000313480907501119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An Acute Trauma Care (ATC) course was adapted for resource-limited healthcare systems based on the American model of initial care for injured patients. The course was taught to interested medical personnel in Kenya. This study undertook a survey of the participants’ healthcare facilities to maximize the applicability of ATC across healthcare settings. The ATC course was conducted three times in Kenya in 2006. A World Health Organization (WHO) Needs Assessment survey was administered to 128 participants. The data were analyzed qualitatively and quantitatively. Ninety-two per cent had a physician available in the emergency department and 63 per cent had a clinical officer. A total of 71.7 per cent reported having a designated trauma room. A total of 96.7 per cent reported running water, but access was uninterrupted more often in private hospitals as opposed to public facilities (92.5 vs 63.6%, P = 0.0005). Private and public employees equally had an oxygen cylinder (95.6 vs 98.5%, P > 0.05), oxygen concentrator (69.2 vs 54.2%, P = 0.12), and oxygen administration equipment (95.7 vs 91.4%, P > 0.05) at their facilities. However, private employees were more likely to report that “all” of their equipment was in working order (53 vs 7.9%, P < 0.0001). Private employees were also more likely to report that they had access to information on emergency procedures and equipment (64.4 vs 33.3%, P = 0.001) and that they had learned new procedures (54.8 vs 25.4%, P = 0.002). Despite a perception of public facility lack, this survey showed that public institutions and private institutions have similar basic equipment availability. Yet, problems with equipment malfunction, lack of repair, and availability of required information and training are far greater in the public sector. The content of the ATC course is valid for both private and public sector institutions, but refinements of the course should focus on varying facets of inexpensive and alternative equipment resources. Furthermore, the implementation of this course should create a setting that advocates, promotes, and investigates resources. The WHO survey can guide future research in understanding impediments to implementing essential trauma care courses for resource limited healthcare systems.
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Affiliation(s)
- Jana B.A. Macleod
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sara Gravelin
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Tait Jones
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Alex Gololov
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michelle Thomas
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Benson Omondi
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - E. Bukusi
- From the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Survey of the bam earthquake survivors' opinions on medical and health system services. Prehosp Disaster Med 2008; 23:382. [PMID: 18935957 DOI: 10.1017/s1049023x00006063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
INTRODUCTION Trauma is a major cause of death and disability worldwide. A quarter of all fatalities due to injury occur due to road traffic crashes with 90% of the fatalities occurring in low- and medium-income countries. Poor compliance with the use of seat belts is a problem in many developing countries. The aim of this study was to evaluate the level of seatbelt compliance in motor vehicles in Benin City, Nigeria. METHODS A five-day, observational study was conducted in strategic locations in Benin City. The compliance rates of drivers, front seat passengers, and rear seat passengers in the various categories of vehicles were evaluated, and the data were subjected to statistical processing using the Program for Epidemiology. RESULTS A total of 369 vehicles were observed. This consisted of 172 private cars, 64 taxis, 114 buses, 15 trucks, and four other vehicles. The seat belt compliance rate for drivers was 52.3%, front seat passengers 18.4%, and rear seat passengers 6.1%. Drivers of all categories of vehicles were more likely to use the seat belt compared to front seat passengers (p = 0.000) and rear seat passengers (p = 0.000). Drivers of private cars were more likely to use seat belts compared to taxi drivers (p = 0.000) and bus drivers (p = 0.000). Front seat passengers in private cars were more likely to use the seat belt compared to front seat passengers in taxis (p = 0.000) and buses (p = 0.000). Rear seat passengers in private cars also were more likely to use seat belts compared to rear seat passengers in taxis (p = 0.000) and buses (p = 0.000). CONCLUSIONS Compliance with seat belt use in Benin City is low. Legislation, educational campaigns, and enforcement of seat belt use are needed.
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Abstract
Female genital cutting (FGC) and HIV/AIDS are both highly prevalent in sub-Saharan Africa, and researchers have speculated that the association may be more than coincidental. Data from 3167 women aged 15-49 who participated in the 2003 Kenya Demographic and Health Survey (KDHS) are used to test the direct and indirect associations of FGC with HIV. Our adjusted models suggest that FGC is not associated directly with HIV, but is associated indirectly through several pathways. Cut women are 1.72 times more likely than uncut women to have older partners, and women with older partners are 2.65 times more likely than women with younger partners to test positive for HIV Cut women have 1.94 times higher odds than uncut women of initiating sexual intercourse before they are 20, and women who experience their sexual debut before age 20 have 1.73 times higher odds than those whose sexual debut comes later of testing positive for HIV. Cut women have 27 percent lower odds of having at least one extra-union partner, and women with an extra-union partner have 2.63 times higher odds of testing positive for HIV. Therefore, in Kenya, FGC may be an early life-course event that indirectly alters women's odds of becoming infected with HIV through protective and harmful practices in adulthood.
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Affiliation(s)
- Kathryn M Yount
- Department of Sociology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 724, Atlanta, GA 30322, USA.
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Abstract
Wrist injury is common and may significantly impair the overall function of the upper extremity unless properly managed. Fractures of the distal radius are particularly common among the aging population, accounting for nearly 1/6 of all fractures, often as a result of increased longevity with the subsequent underlying osteoporosis. New diagnostic tools, including wrist arthroscopy, magnetic resonance imaging, or computed tomography, are increasingly available in developed countries allowing accurate recognition and more effective resolution of lesions which would be otherwise missed using conventional methods. First world treatment standards, however, can scarcely be introduced in developing countries owing to, among other factors, different prevalence of problems, and the lack of resource to implement most modern technologies. If any program needs to be introduced that meets the demands of wrist injury management in the third world, aside from a better regionalisation of trauma care, it should emphasise adequate training of professionals in the use of more cost effective techniques of fracture reduction and stabilisation, applicable everywhere, with the minimum possible morbidity.
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Affiliation(s)
- Marc Garcia-Elias
- Institut Kaplan, Hand and Upper Extremity Surgery, Passeig de la Bonanova, 9, 2on 2a, 08022 Barcelona, Spain.
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