Mapping of pathways of care, assessment of delays and gap analysis in provision of care following road traffic injury among patients in selected tertiary hospitals in urban Karnataka, South India

Background: Evidence-based public health advocates decision making based on best available scientific evidence, hence it is important to gather evidence of current scenario of trauma care. Aim & Objective: To determine pathways of care and delays among Road Traffic Injury patients and assess gaps in resources. Settings and Design: This cross-sectional study was conducted in selected tertiary care hospitals in Mangaluru taluk, Karnataka. Methods and Material: Participants were administered validated proformas on prehospital and hospital care. WHO trauma care checklist was used for capacity assessment and gap analysis. Statistical analysis used: Time intervals are expressed as measures of central tendency and dispersion. Descriptive analysis is given as percentages and proportions. Results: Median pre-hospital time was 30 minutes. Overall, 67.5% of the patients reached within golden hour. Majority (64.1%) were directly transported to current hospital. All patients received first aid, but only 0.8% received it at the RTI site. First aid was mostly administered by doctors (68.7%) or nursing staff (31.1%) and none by bystander. Insurance coverage was 32.8% and 87.9% incurred out of pocket expenditures. Scores were low in GP level hospital. Conclusions: Although transport was within the golden hour, pre-hospital care was poor. Out of pocket expenditures were high.

Provision of Care Following Road Traffic Injuries in a District in South India: A Qualitative Analysis of Stakeholder Perspective

Introduction:

It is essential to explore ways to prevent and reduce the severity of injuries in road crashes. This study attempts at getting a ground-level understanding of perspectives surrounding road traffic injury among various stakeholders.

Materials and Methods:

In-depth interviews and focused group discussions were conducted over a period of 6 months among traffic police, toll booth operators, road transport officers, nurses, and intensive care specialists. The transcribed data were coded and analyzed, and a percentage of final themes as well as codes were drawn.

Results:

The common reasons cited for delay in transport of accident victims were fear regarding medicolegal issues among the first responders (36.9%) and delay in ambulance (41.5%). 26.1% agreed that time delay in transport can be reduced by generating awareness. Teaching first aid to the general public is essential as opined by 75% of nursing staff and 66.7% of emergency physicians. Documentation procedures (15.4%), long waiting hours (10.2%), and out-of-pocket expenditure and financial constraints (10.2%) were the commonly cited reasons for problems faced by patient bystanders.

Conclusions:

Creating awareness and improving access to ambulance were the two essential recommendations to prevent delay in prehospital care. Majority of the care providers and patient bystanders agreed that improving insurance coverage is essential to reduce financial constraints.

Lifestyle, dietary and treatment adherence pattern of uncontrolled diabetics in coastal Karnataka, India

Background: Diabetes Mellitus shows a rising trend in India, driven by a combination of factors like sedentary lifestyle, unhealthy diet and tobacco use. The cornerstone for interventions to reduce this is lifestyle modification. Aim & Objective: This study aims to determine lifestyle behaviours among uncontrolled diabetics in rural South India. Settings and Design: This is a pilot study conducted as part of a community trial which enrolled uncontrolled diabetics (Glycosylated haemoglobin, HbA1C of 7% or more) selected from baseline survey of 2 RBS readings. Methods and Material: The sociodemographic details, lifestyle habits and treatment adherence of eligible participants were recorded with a validated questionnaire. Statistical analysis used: Data was compared among 2 groups of poor glycaemic control using Chi square test. Results: There was no significant association of age or gender with HbA1C levels. Majority were non-smokers, non-alcoholics and did not exercise. Higher proportions of those with hospital admissions, longer duration of disease and less frequent check-ups had poor control; but these were not statistically significant. Dietary control was inadequate. However, there were no significant association of dietary habits with poor control. Conclusions: Although overall adherence to medication and follow up was satisfactory, lifestyle modification is not being sufficiently followed.