Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study

Purcell, Laura N.; Nip, Emily; Gallaher, Jared; Varela, Carlos; Gondwe, Yotamu; Charles, Anthony

doi:10.1016/j.injury.2020.04.044

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…A hospital-based trauma registry in Malawi cited low startup costs of $3,196 USD but required an annual budget of $29,697 to maintain. 23 Capturing trauma data at a regional and national level is exponentially more expensive.…”

Section: Discussionmentioning

confidence: 99%

Piloting a Layperson Prehospital Care System in Rural Uganda

Brown

Stratton

Gill

et al. 2023

Prehosp. Disaster med.

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Introduction: In many low-income countries, basic prehospital Emergency Medical Services (EMS) remain under-developed, resulting in significant delays or the complete inability to access care. Study Objective: The purpose of this study was to analyze the effectiveness of a layperson EMS training targeting motorcycle taxi (boda) drivers in a rural region of Uganda. Methods: Fifty (50) adult boda drivers from Masindi, Uganda were selected for a one-day training course including lectures and simulation. Course content covered basic prehospital skills and transport. Participants were given a first responder kit at completion of the course. Understanding of material was assessed prior to training, immediately after course completion, and four months from the initial course using the same ten question test. Test means were analyzed using a standard linear regression model. At the four-month follow up, all 50 boda drivers participated in semi-structured small group qualitative interviews regarding their perception of the course and experiences implementing course skills in the community. Boda drivers were asked to complete a brief form on each patient transported during the study period. For patients transported to Masindi Kitara Medical Center (MKMC), hospital trauma registry data were analyzed. Results: Trainees showed both knowledge acquisition and retention with pre-test scores of 21.8% improving to 48.0% at course completion and 57.7% at the four-month follow up. Overall, participant’s scores increased by an average of 35% from the pre-test to the second post-test (P <.001). A total of 69 patient forms were completed on transported patients over the initial four-month period. Ninety-five percent (95%) of these were injured patients, and motorcycle crash was the predominant mechanism of injury (48% of injuries). Eight patients were transported to MKMC, but none of these patients were recorded in the hospital trauma registry. Major barriers identified through semi-structured interviews included harassment by police, poor road conditions, and lack of basic resources for transport. Ninety-four percent (94%) of trainees strongly agreed that the training was useful. Total costs were estimated at $3,489 USD, or $69 per trainee. Conclusion: Motorcycle taxi drivers can be trained to provide basic prehospital care in a short time and at a low cost. While there is much enthusiasm for additional training and skill acquisition from this cohort, the sustainability and scalability of such programs is still in question.

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Section: Discussionmentioning

confidence: 99%

Piloting a Layperson Prehospital Care System in Rural Uganda

Brown

Stratton

Gill

et al. 2023

Prehosp. Disaster med.

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“…Trauma registries enable prospective data collection of injured patients and are advocated to optimise surveillance and quality improvement for injury care in health systems 7. Although present in some places,8 9 widespread registry adoption has been constrained in LMICs to date 10. However, even when in existence, hospital facility-based trauma registries do not capture information on those injured patients who die before reaching the hospital.…”

Section: Introductionmentioning

confidence: 99%

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data

Whitaker,

Edem,

Amoah

et al. 2024

BMJ Open

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ObjectivesTo use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care.DesignRetrospective analysis of existing VA data routinely collected by a demographic surveillance site.SettingKaronga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi.ParticipantsFatally injured members of the HDSS.Primary and secondary outcome measuresThe primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system.ResultsOf the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11–48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, ‘healthcare literacy’ was most commonly implicated barrier in 75% (15/20). Within Delay 2, ‘communication’ and ‘prehospital care’ were the most commonly implicated in 92.5% (37/40). Within Delay 3, ‘physical resources’ were most commonly implicated, 85.7% (42/49).ConclusionsVA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system.

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“…The development of trauma registries for prospective collection of trauma patient data supports surveillance and care improvements in HIC settings [ 10 ]. Whilst there are examples of successfully established registries in LMICs [ 11 , 12 ], resource constraints have limited their widespread adoption [ 13 ]. Trauma registries are also limited to only recording patients with injuries treated in a facility and will not include those who choose not to seek care or do not survive to reach care.…”

Section: Introductionmentioning

confidence: 99%

Access to quality care after injury in Northern Malawi: results of a household survey

Whitaker,

Amoah,

Dube

et al. 2024

BMC Health Serv Res

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Background Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury. Methods We administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1–29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked. Results Most households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142). Conclusion Injuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.

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Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study

Cited by 7 publications

References 18 publications

Piloting a Layperson Prehospital Care System in Rural Uganda

Piloting a Layperson Prehospital Care System in Rural Uganda

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data

Access to quality care after injury in Northern Malawi: results of a household survey

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