Training Laypersons and Hospital Personnel in Basic Resuscitation Techniques: an Approach to Impact the Global Trauma Burden in Mozambique

Merchant, Amina; Outhay, Malena; Gonzaléz-Calvo, Lazáro; Moon, Troy D.; Sidat, Mohsin; Taibo, Cátia Luciana Abdulfattáhe; McQueen, Kelly

doi:10.1007/s00268-015-2966-z

Cited by 23 publications

(28 citation statements)

References 18 publications

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“…Given the financial and resource constraints in low-income countries, simple but systematic pre-hospital training programs have been implemented in rural villages to stabilize patients. Most pre-hospital deaths are the result of airway compromise, respiratory failure or uncontrolled hemorrhage; all three of these conditions can be addressed using basic first aid measures [ 5 ]. Supporting this information with data from a trauma registry can improve efforts toward pre-hospital care.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these deaths occurred in low- and middle-income countries (LMIC), with the World Health Organization (WHO) estimating that injury is responsible for more deaths than HIV, malaria, and tuberculosis combined [ 2 – 4 ]. The cost of trauma related injury remains exorbitant, both in terms of the economic consequences for society, as well as the fact that they account for 11 % of estimated disability adjusted life years (DALYS) for those living with the sequela of injury [ 5 , 6 ]. These sequelae disproportionately affect LMIC due to inadequate surgical and anesthesiology services, poor rehabilitation systems, and minimal social safety nets [ 2 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated, that of patients that die of trauma related injuries in LMIC, roughly 80.0 % die in the pre-hospital setting [ 5 , 8 ]. Reductions in injury-associated morbidity and mortality have been linked to a variety of factors including adequate pre-hospital care, decreased transportation time to definitive care, reinforced transportation laws to diminish road traffic injuries (RTI), and improved injury surveillance [ 5 , 6 , 9 ]. Moreover, the addition of basic surgical services could avert approximately 21.0 % of the injury burden of LMIC [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Mozambique is a resource-limited country on the southeast coast of Africa with a population of 25 million persons [ 5 ]. It ranked 178 of 187 nations on the 2014 United Nations Development Program (UNDP) Human Development Index (HDI), with a gross national income estimated at US $1011 per capita [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of trauma admission data at an urban hospital in Maputo, Mozambique

et al. 2016

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BackgroundTrauma is a major public health concern. Worldwide, injuries resulted in 4.8 million deaths in 2013, an increase of 11 % since 1990. The majority of deaths from trauma in low-and middle-income countries occur in a pre-hospital setting. Morbidity from trauma contributes significantly to disability in these countries. Mozambique has experienced a rise in injury-related morbidity and mortality. Efforts are underway to prioritize surgical and anesthesiology care in the post-2015 Global Surgery agenda that will build on momentum of the Millennium Development Goals. Injury surveillance remains vital to defining priorities and implementing policy changes.MethodsWe performed a cross-sectional study between June and September, 2010 at the Hospital Central de Maputo (HCM). Data were collected on all patients admitted to the HCM emergency surgical services with a diagnosis of trauma. We describe patient characteristics and mechanism of traumatic injury by calculating simple proportions (for dichotomous or categorical variables) or medians with interquartile ranges (IQR) for continuous variables. Multivariable logistic regression analysis was used to estimate the mechanisms of trauma most associated with alcohol consumption.ResultsA total of 517 patients were approached for inclusion in this study. Of these, 441 (91.5 %) participants were followed from admission until discharge. Three hundred twenty-four participants (73.5 %) were male. The most common age group was 20–29 years old. The three principal mechanisms of injury were road traffic injury, fighting, and falls, accounting for 74 % of injuries recorded. Traumatic injury involving alcohol consumption was nine times more likely to occur at a recreation/sporting event (OR 9.0, 95 % CI 3.01–27.13, p ≤ 0.0001).ConclusionsAs Mozambique prepares to respond to the post-2015 international development agenda, urgent action is required to scale-up its national injury surveillance networks. Injury prevention efforts in Mozambique should focus attention on improving road safety regulations and their implementation, as well as on interventions targeting violence reduction and the reduction of alcohol consumption at sporting events.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of trauma admission data at an urban hospital in Maputo, Mozambique

et al. 2016

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“…This starts with rapid and appropriate pre-hospital care and transport. In LMIC, it is estimated that 80% of road traffic deaths occur before patients even reach a hospital [ 3 ]. Although much of this mortality may be attributed to rural regions, where collision speeds are often higher and transport times longer [ 4 ], pre-hospital delays remain a significant contributor to excess road traffic mortality in urban contexts as well, despite increased ambulance availability [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia

et al. 2018

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BackgroundAfrica accounts for one sixth of global road traffic deaths—most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined.MethodsThis is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes.ResultsOver half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16–4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86–2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49–1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity.ConclusionsDespite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0158-5) contains supplementary material, which is available to authorized users.

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