Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage

Abstract

BackgroundRoad traffic injuries (RTIs) are a cause of significant morbidity and mortality in low- and middle-income countries. Access to timely emergency services is needed to decrease the morbidity and mortality of RTIs and other traumatic injuries. Our objective was to describe the distribution of roadtrafficcrashes (RTCs) in Nairobi with the relative distance and travel times for victims of RTCs to health facilities with trauma surgical capabilities.MethodsRTCs in Nairobi County were recorded by the Ma3route app from May 2015 to October 2015 with latitude and longitude coordinates for each RTC extracted using geocoding. Health facility administrators were interviewed to determine surgical capacity of their facilities. RTCs and health facilities were plotted on maps using ArcGIS. Distances and travel times between RTCs and health facilities were determined using the Google Maps Distance Matrix API.Results89 percent (25/28) of health facilities meeting inclusion criteria were evaluated. Overall, health facilities were well equipped for trauma surgery with 96% meeting WHO Minimal Safety Criteria. 76 percent of facilities performed greater than 12 of three pre-selected ‘Bellweather Procedures’ shown to correlate with surgical capability. The average travel time and distance from RTCs to the nearest health facilities surveyed were 7 min and 3.4 km, respectively. This increased to 18 min and 9.6 km if all RTC victims were transported to Kenyatta National Hospital (KNH).ConclusionAlmost all hospitals surveyed in the present study have the ability to care for trauma patients. Treating patients directly at these facilities would decrease travel time compared with transfer to KNH. Nairobi County could benefit from formally coordinating the triage of trauma patients to more facilities to decrease travel time and potentially improve patient outcomes.Level of evidenceIII

Self‐reported involvement in road traffic crashes in Kenya: A cross‐sectional survey of a nationally representative sample

“…25 In contrast to its rural areas, health facilities within Kenya's capital city of Nairobi are reported to have adequate trauma care infrastructure in terms of physical and human resources, with 96% of facilities in the capital meeting the WHO minimal safety criteria. 28 However, it should be pointed out that while 19% of injuries resulting from RTCs in Kenya are severe, 29 only 1.4% of RTC casualties are transported by ambulance and only 49.6% of such patients arrive at trauma centers within 1 hour following the trauma incident. 15 In addition, only 7.4%−16% are likely to have received any form of first aid as the majority of patients are transported to hospitals by unidentified lay individuals.…”

“…25 In contrast to its rural areas, health facilities within Kenya's capital city of Nairobi are reported to have adequate trauma care infrastructure in terms of physical and human resources, with 96% of facilities in the capital meeting the WHO minimal safety criteria. 28 …”

“…In terms of dealing with the aftermath of potential injuries arising from RTCs, Kenya experiences shortages of basic medical supplies for trauma care with only 40.8% of its health facilities being adequately prepared to handle road‐traffic injured patients 25 . In contrast to its rural areas, health facilities within Kenya's capital city of Nairobi are reported to have adequate trauma care infrastructure in terms of physical and human resources, with 96% of facilities in the capital meeting the WHO minimal safety criteria 28 …”

Driving to Childhood Cancer Hub Hospitals: A Study on Hospital Accessibility in Japan

“…web API, as a new and simple method to conduct similar analyses (Shaw et al, 2017;Sommerhalter et al, 2017). Of particular note is the Google Maps Platform service and its various web APIs (Google Maps APIs).…”

“…By using the Google Maps API, travel times and distances were calculated in consideration of various factors (Google Maps Platform, 2020). In addition, previous studies have used the Google Distance Matrix API, a Google Maps API, to return ETT and ETD results only (Shaw et al, 2017;Sommerhalter et al, 2017). However, our study used the Google Directions API, which provided additional details for directions, in order to confirm whether ferry use was required and thus enabled us to exclude those areas from analysis when needed.…”