A review of existing trauma and musculoskeletal impairment (TMSI) care capacity in East, Central, and Southern Africa

Background Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated. Methods A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem. Results Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were “ Training and retention of specialist staff ”, “ Health education/awareness of injury severity ”, “ Geographical coverage of referral trauma centres ”, and “ Lack of protocol for bypass to referral centres ”. The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map. Conclusion Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.

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“…Injury: Mpirimbanyi et al [ 24 ], Calland et al [ 40 ], Chokotho et al [ 39 ], Ntakiyiruta et al [ 44 ]…”

Section: Resultsmentioning

confidence: 99%

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

et al. 2020

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“…In Rwanda, a national survey of musculoskeletal impairments found 2.6% of children were impaired, 80,000 needed physical therapy, and 10,000 needed assistive devices [ 43 ]. An assessment of orthopedic surgical capacity in East, Central, and Southern Africa found 36% of district hospitals in rural areas had rehabilitation units with very few hospitals having a trained rehabilitation specialists [ 44 ]. One way to expand capacity is to strengthen the link between hospitals and rehabilitation services through direct referral systems and educational interventions while in the hospital to the family caregivers.…”

Section: Discussionmentioning

confidence: 99%

Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda

Smith

Water

Martin

et al. 2018

BMC Health Serv Res

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BackgroundCommunity services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need.MethodsThis study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services.ResultsOf 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions.ConclusionsOur study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.

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“…[17][18][19][20][21] The need to improve trauma care for RTIs in LMICs is widely recognized, but limited progress has been made thus far. [22,23] One limitation of this cross-sectional analysis is that it focused on hospitals located near the main north-south highway in Malawi.…”

Section: Discussionmentioning

confidence: 99%

Improving hospital-based trauma care for road traffic injuries in Malawi

Chokotho

Mulwafu

Singini

et al. 2017

World Journal of Emergency Medicine

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A review of existing trauma and musculoskeletal impairment (TMSI) care capacity in East, Central, and Southern Africa

Cited by 27 publications

References 33 publications

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda

Improving hospital-based trauma care for road traffic injuries in Malawi

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