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Akbar Mohammadi A, Goodarzian MR, Parvar SY, Rafiei E, Keshavarz M, Zardosht M. Epidemiology of Burn Injuries Among Adult Females in Southern Iran; A Retrospective Study from 2007 to 2022. J Burn Care Res 2024; 45:638-643. [PMID: 37325927 DOI: 10.1093/jbcr/irad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 06/17/2023]
Abstract
Burn-by flame, flush, scald, electrical, and chemical types-accounts for 5%-12% of trauma injuries worldwide. In Iranian studies, females were the main victims of domestic burns with higher mortality and frequencies. This retrospective study evaluates the epidemiology and etiology of burn injuries in females aged 25-64 years between October 2007 and May 2022 in southern Iran. Demographics and burn etiology information were collected by questionnaires at admission. Univariate and multivariate regression analysis was used to determine the relationship between variables and burn mortality. Pearson's Chi-Square and One-way ANOVA tests were utilized to compare different burn etiologies. Of 3212 females with burn injuries, 1499 (46.6%) were included with a mean age of 38.5 ± 10.8 years. Flame (59.7%) and flush (28.9%) were significantly the most common injuries mechanism. Burn was most common in rural areas (53.9%) and indoor settings (62.1%) (P-value < .001). 77.9% of the population were under-diploma (P-value < .001), and 3.5% were divorced with higher burn-suicide attempts. The mean Total Body Surface Area (TBSA%) was 41.1 ± 28.3%, and the mean Length of Stay (LOS) was 14.5 ± 13.2 days with a 39.1% mortality rate. With univariate and multivariate analysis, TBSA%, indoor places, flame, flush, and urban living were risk factors for burn mortality. Briefly, flame in indoor settings is the most common type of burn injury affecting adult females with lower educational levels living in rural areas. Such epidemiological studies of burns in adult females may be helpful for health policymakers to develop burn prevention programs.
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Affiliation(s)
- Ali Akbar Mohammadi
- Department of Plastic Surgery, Amir-al-Moemenin Hospital, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MReza Goodarzian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Elham Rafiei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Keshavarz
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Zardosht
- Department of Plastic Surgery, Amir-al-Moemenin Hospital, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Delaney PG, Eisner ZJ, Pine H, Klapow M, Thullah AH, Bamuleke R, Nuur IM, Raghavendran K. Leveraging transportation providers to deploy lay first responder (LFR) programs in three sub-Saharan African countries without formal emergency medical services: Evaluating longitudinal impact and cost-effectiveness. Injury 2024; 55:111505. [PMID: 38531720 DOI: 10.1016/j.injury.2024.111505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION In 2019, the World Health Assembly declared emergency care essential to achieve the 2030 Sustainable Development Goals. Few sub-Saharan African (SSA) countries have developed robust approaches to sustainably deliver emergency medical services (EMS) at scale, as high-income country models are financially impractical. Innovative reassessment of EMS delivery in resource-limited settings is necessary as timely emergency care access can substantially reduce mortality. MATERIALS AND METHODS We developed the Lay First Responder (LFR) program by training 1,291 pre-existing motorcycle taxi drivers, a predominant form of short-distance transport in sub-Saharan Africa, to provide trauma care and transport for road traffic injuries. Three pilot programs were launched in staggered fashion between 2016 and 2019 in West, Central, and East Africa and a 5.5 h curriculum was iteratively developed to train first responders. Longitudinal data on patient impact (patient demographics, injury characteristics, and treatment rendered), emergency care knowledge acquisition/retention, and social/financial effects of LFR training were collected and pooled across three sites for collective analysis. Novel cost-effectiveness ratios were calculated based on prospective cost data from each site. Previously projected aggregate disability-adjusted life years (DALYs) addressable by LFRs were used to inform cost-effectiveness ratios($USD cost per DALY averted). Cost-effectiveness ratios were then compared against African per capita gross domestic product (GDP), following WHOCHOICE guidelines, which state ratios less than GDP per capita are "very cost-effective." RESULTS In 2,171 total patient encounters across all three pilot sites, LFRs most frequently provided hemorrhage control in 61 % of patient encounters and patient transport by motorcycle in 98.5 %. Median pre-/post-test scores improved by 34.1 percentage points (39.5% vs.73.6 %, p < 0.0001) with significant knowledge retention at six months. 75 % of initial participants remain voluntarily involved 3 years post-course, reporting increased local stature and customer acquisition(income 32.0 % greater than non-trained counterparts). Locally sourced first-aid materials cost $6.54USD/participant. Cost-effectiveness analysis demonstrated cost per DALY averted=$51.65USD. CONCLUSION LFR training is highly cost-effective according to WHOCHOICE guidelines and expands emergency care access. The LFR program may be an alternative approach to formal ambulance-reliant EMS that are cost-prohibitive in resource-limited, sub-Saharan African settings. A novel social/financial mechanism appears to incentivize long-term voluntary LFR involvement, which may sustain programs in resource-limited settings.
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Affiliation(s)
| | | | - Haleigh Pine
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Max Klapow
- Oxford University, Oxford, England, United Kingdom
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Tilahun L, Zeleke M, Desu B, Dagnew K, Nega A, Birrie E, Estifanos N, Tegegne A, Feleke A. Time to recovery and its predictors following traumatic injuries among injured victims in Dessie Comprehensive Specialized Hospital, North East of Ethiopia, 2022: a retrospective follow-up study. BMC Emerg Med 2024; 24:44. [PMID: 38500020 PMCID: PMC10949805 DOI: 10.1186/s12873-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Injuries are an extremely important public health problem worldwide. Despite being largely preventable and despite government efforts, injuries continue to be a major public health issue. Thus, the study tends to evaluate the time to recovery and its predictors for traumatic injuries. METHODS A hospital-based retrospective follow-up study was used. A total of 329 medical charts were actually reviewed. Traumatic injury victims from January 1, 2018-December 31, 2022 were included, and a simple random sampling technique was utilized. The data was gathered by reviewing medical charts. Data was coded and entered into Epi-Data Manager version 4.6.0.4 statistical software and further analyzed using STATA version 17. Descriptive statistics were performed to see the frequency distribution of variables. A Kaplan-Meier survival estimate and log rank test were performed to plot the overall survival curve and compare the difference in recovery among predictor categories, respectively. A model fitness test was done by using the Cox-Snell residual test and Harrell's C concordance statistic. Finally, a Cox proportional hazard model was fitted to determine the effect of predictors on recovery time from traumatic injuries. RESULTS The median time to recovery of traumatic injuries was 5 days (IQR: 3-10 days), with an overall incidence density of 8.77 per 100 person-days of observation. In the multivariable cox proportional regression model, variables such as being male (AHR: 0.384, 95%CI: 0.190-0.776, P-value: 0.008), the Glasgow coma scale of 13-15 (AHR: 2.563, 95%CI: 1.070-6.139, P-value: 0.035), intentional injury (AHR: 1.934, 95%CI: 1.03-3.632, P-value: 0.040), mild traumatic brain injury (AHR: 2.708, 95%CI: 1.095-6.698, P-value: 0.031), and moderate traumatic brain injury (AHR: 2.253, 95%CI: (1.033-4.911, P-value: 0.041) were statistically significant variables. CONCLUSIONS The median recovery time for traumatically injured respondents was 5 days. Independent predictors such as the Glasgow coma scale, time taken for surgical management, intent of injury, and traumatic brain injury were statistically significant with time to recovery from trauma.
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Affiliation(s)
- Lehulu Tilahun
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia.
| | - Mulusew Zeleke
- College of Medicine and Health Sciences, Department of Adult Health Nursing, Wollo University, Dessie, Ethiopia
| | - Birhanu Desu
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Kirubel Dagnew
- College of Medicine and Health Sciences, Department of Comprehensive Nursing, Wollo University, Dessie, Ethiopia
| | - Aytenew Nega
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Endalk Birrie
- College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Wollo University, Dessie, Ethiopia
| | - Nathan Estifanos
- College of Medicine and Health Sciences, Department of Comprehensive Nursing, Wollo University, Dessie, Ethiopia
| | - Akele Tegegne
- College of Medicine and Health Sciences, Department of Emergency and Ophthalmic Nursing, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Asresu Feleke
- College of Medicine and Health Sciences, Department of Emergency and Critical Care Nursing, Dilla University, Dilla, Ethiopia
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Whitaker J, Amoah AS, Dube A, Rickard R, Leather AJM, Davies J. Access to quality care after injury in Northern Malawi: results of a household survey. BMC Health Serv Res 2024; 24:131. [PMID: 38268016 PMCID: PMC10809521 DOI: 10.1186/s12913-023-10521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
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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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Abena S Amoah
- Malawi Epidemiology and Intervention Research Unit (Formerly Karonga Prevention Study), Chilumba, Malawi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (Formerly Karonga Prevention Study), Chilumba, Malawi
| | - Rory Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Ghalichi L, Goodman-Palmer D, Whitaker J, Abio A, Wilson ML, Wallis L, Norov B, Aryal KK, Malta DC, Bärnighausen T, Geldsetzer P, Flood D, Vollmer S, Theilmann M, Davies J. Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002768. [PMID: 38241424 PMCID: PMC10798533 DOI: 10.1371/journal.pgph.0002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024]
Abstract
Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.
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Affiliation(s)
- Leila Ghalichi
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Dina Goodman-Palmer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- King’s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Anne Abio
- Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Lee Wallis
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Bolormaa Norov
- Department of Nutrition and Food Safety, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Departamento de Enfermagem Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub–San Francisco, San Francisco, California, United States of America
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Michaela Theilmann
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Kumar M, Pathak VK, Tripathi S, Upadhyay A, Singh VV, Lahariya C. Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review. Indian J Community Med 2023; 48:648-658. [PMID: 37970167 PMCID: PMC10637604 DOI: 10.4103/ijcm.ijcm_887_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/17/2023] [Indexed: 11/17/2023] Open
Abstract
Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.
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Affiliation(s)
- Mohan Kumar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People Centric Health System, New Delhi, India
| | - Vineet Kumar Pathak
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People Centric Health System, New Delhi, India
| | - Saparya Tripathi
- Department of Psychiatry, SGT Medical College, Gurugram, Haryana, India
| | - Anita Upadhyay
- Director-Projects, Human Capital Lighthouse Pvt. Ltd, New Delhi, India
| | - Vivek V. Singh
- Health Specialist, UNICEF India Country Office, New Delhi, India
| | - Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People Centric Health System, New Delhi, India
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Abio A, Ngum P, Lowery Wilson M, Bärnighausen T, Lule H. Sociodemographic distribution and correlates of nonfatal unintentional non-traffic-related injuries in Kenya: Results from the 2014 demographic and health survey. Health Sci Rep 2023; 6:e1323. [PMID: 37292100 PMCID: PMC10246455 DOI: 10.1002/hsr2.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Background and Aim Injuries are among the leading causes of mortality worldwide. There exists a paucity of nationally representative injury data from the sub-Saharan African region on the nature of injuries outside of road traffic contexts. The aim of this study was to estimate the prevalence of nonfatal unintentional injuries that occurred outside of the traffic environment among persons aged 15-54 years in Kenya. Methods We used the 2014 Kenyan Demographic Health Survey data to estimate the prevalence of nonfatal unintentional injuries and their injury mechanisms. Binary logistic regression was used to estimate the odds of unintentional injuries and associated factors. Results Injury prevalence was three times higher among males (27.56%) compared to females (8.25%). The highest prevalence for females and males respectively was among those aged 15-19 years (9.80%) and (31.18%), rural residents (8.45%) and (30.05%) and those who consumed alcohol (18.13%), and (31.39%). For both females and males, the most frequent injuries were cuts (4.95%; 18.15%) and as result of falls (3.29%; 8.92%) respectively. Burns were more prevalent among females (1.65%) compared to males (0.76%). Among males, the demographic and contextual factors associated with nontraffic unintentional injuries were residing in a rural area (OR 1.33, 95% CI 1.14, 1.56), primary education (OR 2.02, 95% CI 1.48, 2.76), a higher wealth index (second quintile OR 1.41, 95% CI 1.19, 1.67) and consuming alcohol (OR 1.49, 95% CI 1.32, 1.69). Females who had completed primary, secondary (OR 2.43, 95% CI 1.92, 3.08) or higher education had higher odds of unintentional injuries. Conclusion The findings mirror prior literature highlighting the clustering of demographic and behavioral factors which underlie predisposition to injuries outside of the traffic environment. Future nationally representative studies would benefit from deeper inquiry into and measurement of injury severity and health care utilization to inform strategic policy-relevant research.
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Affiliation(s)
- Anne Abio
- Department of Clinical NeurosciencesInjury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital, University of TurkuTurkuFinland
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of HeidelbergHeidelbergGermany
| | - Peter Ngum
- Department of NeurologyTurku Brain Injury Center, Turku University Hospital, University of TurkuTurkuFinland
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of HeidelbergHeidelbergGermany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of HeidelbergHeidelbergGermany
| | - Herman Lule
- Department of Clinical NeurosciencesInjury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital, University of TurkuTurkuFinland
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Howard A, Bolton W, Wood A, Hodgson H, Scott J, Jayne D, Bundu I. There is a great variety of orthopaedic conditions presenting to a large hospital in Sierra Leone: a 3-year prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:581-585. [PMID: 36241914 PMCID: PMC10036420 DOI: 10.1007/s00590-022-03380-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/28/2022] [Indexed: 03/25/2023]
Abstract
PURPOSE In Sierra Leone there is a large void in orthopaedic research into the type of orthopaedic injuries, both acute and chronic. Improved data collection is essential in providing insight to guide health care planning and research. This study aims to outline the types of orthopaedic injury sustained. METHOD Data were prospectively collected by local surgeons in the Orthopaedic outpatient department at a large hospital between January 2016 and January 2019. RESULTS The orthopaedic department saw a mean 728 patients per year, with mean age 24.0 years. The workload comprised of 64.92% acute orthopaedic conditions or their complications, with 35.08% elective orthopaedics. Fractures made up the largest proportion of clinical appointments, annually 244.33 fractures; however there was a high incidence of osteomyelitis. CONCLUSION The study gives an important insight into the types and distribution of elective and trauma orthopaedic injuries sustained in Sierra Leone, which has not been previously reported, and highlights key areas where resources may be focused in order to improve clinical outcomes.
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Affiliation(s)
- Anthony Howard
- NDORMS, Oxford University, Oxford, UK.
- LIRMM, Academic Department, Leeds General Infirmary, University of Leeds, Leeds, UK.
| | - William Bolton
- Leeds Institute of Medical Research, St James, University of Leeds, Leeds, UK
| | | | - Harry Hodgson
- LIRMM, Academic Department, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Julian Scott
- Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, St James, University of Leeds, Leeds, UK
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Ahmed Nour FM, Tiee MS, Oke RA, Motwani GN, Azemafac KE, Mbeboh SN, Embolo FN, Dickson DC, Dicker RA, Juillard C, Christie SA, Chichom-Mefire A. Limb Injuries and Disability in the Southwest Region of Cameroon. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202302000-00009. [PMID: 36795867 PMCID: PMC9937092 DOI: 10.5435/jaaosglobal-d-22-00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/26/2022] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Extremity injuries are a leading cause of morbidity in low- and middle-income countries (LMICs), often resulting in marked short-term and long-term disabilities. Most of the existing knowledge on these injuries originates from hospital-based studies; however, poor access to health care in LMICs limits these data because of inherent selection bias. This subanalysis of a larger population-level cross-sectional study in the Southwest Region of Cameroon aims to determine patterns of limb injury, treatment-seeking behaviors, and predictors of disability. METHODS Households were surveyed in 2017 on injuries and subsequent disability sustained over the previous 12 months using a three-stage cluster sampling framework. Subgroups were compared using the chi square, Fisher exact, analysis of variance, Wald, and Wilcoxon rank-sum tests. Logarithmic models were used to identify predictors of disability. RESULTS Of 8,065 subjects, 335 persons (4.2%) sustained 363 isolated limb injuries. Over half of the isolated limb injuries (55.7%) were open wounds while 9.6% were fractures. Isolated limb injuries most commonly occurred in younger men and resulted from falls (24.3%) and road traffic injuries (23.5%). High rates of disability were reported, with 39% reporting difficulty with activities of daily living. Compared with individuals with other types of limb injuries, those with fractures were six times more likely to seek a traditional healer first for care (40% versus 6.7%), 5.3 times (95% CI, 1.21 to 23.42) more likely to have any level of disability after adjustment for injury mechanism, and 2.3 times more likely to have difficulty paying for food or rent (54.8% versus 23.7%). DISCUSSION Most traumatic injuries sustained in LMICs involve limb injuries and often result in high levels of disability that affect individuals during their most productive years. Improved access to care and injury control measures, such as road safety training and improvements to transportation and trauma response infrastructure, are needed to reduce these injuries.
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Affiliation(s)
- Fonje Mouansie Ahmed Nour
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Madeline S. Tiee
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Rasheedat A. Oke
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Girish N. Motwani
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Kareen E. Azemafac
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Susana N. Mbeboh
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Frida N. Embolo
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Drusia C. Dickson
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Rochelle A. Dicker
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Catherine Juillard
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - S. Ariane Christie
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
| | - Alain Chichom-Mefire
- From the Faculty of Health Sciences, University of Buea, Buea, Cameroon (Dr. Ahmed Nour, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, and Dr. Chichom-Mefire); the Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA (Dr. Ahmed Nour, Dr. Tiee, Motwani, Dr. Azemafac, Dr. Mbeboh, Dr. Embolo, Dr. Dickson, and Dr. Christie); the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL (Tiee); and the Program for the Advancement of Surgical Equity, Department of Surgery, University of California, Los Angeles, Los Angeles, CA (Dr. Oke, Dr. Dicker, and Dr. Juillard)
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10
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Peltzer K. Psychosocial factors associated with physical injury among adults in Eswatini. JOURNAL OF PSYCHOLOGY IN AFRICA 2023. [DOI: 10.1080/14330237.2023.2175982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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11
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Parvin-Nejad FP, Padmanaban V, Jalloh S, Barrie U, Sifri ZC. Stop the Bleed in Rural Sierra Leone: One Year of Interventions and Outcomes by Nursing Trainees. J Surg Res 2022; 273:79-84. [PMID: 35032824 DOI: 10.1016/j.jss.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/13/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low- and middle-income countries (LMICs) bear the bulk of the global burden of traumatic injury, yet many lack adequate prehospital trauma care systems. The Stop the Bleed (STB) course, designed to equip bystanders with bleeding control skills, is infrequently offered in LMICs, and its impact in these settings is unknown. To examine the frequency and effectiveness of STB interventions in LMICs, we quantified nursing student trainees' encounters with bleeding victims after STB training in rural Sierra Leone. METHODS Local providers and volunteers from a US-based surgical nongovernmental organization taught an STB course to nursing students in Kabala, Sierra Leone. One month and 1 year after the course, trainees completed follow-up surveys describing encounters with traumatic hemorrhage victims since the course. RESULTS Of 121 total STB trainees, 82 completed the 1-month follow-up survey, with 75% reporting at least one encounter with a bleeding victim. This increased to 98% at 12 months (100 responses, average 2 ± 2 encounters). Injuries were most commonly sustained on victims' legs (32%) and most often precipitated by motorcycle crashes (31%). Respondents intervened in 99% of encounters, and 97% of patients receiving intervention survived. Although only 20% of respondents used a tourniquet, this technique produced the highest survival rate (100%). CONCLUSIONS Nearly all respondents had encounters with victims of traumatic hemorrhage within 1 year of the STB course, and trainees effectively applied bleeding control techniques, leading to 97% survival among victims receiving intervention. These findings indicate the lifesaving impact of STB training in one rural LMIC setting.
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Affiliation(s)
| | - Vennila Padmanaban
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
| | - Samba Jalloh
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Umaru Barrie
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Ziad C Sifri
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
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12
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Jensen GW, Lafta R, Burnham G, Hagopian A, Simon N, Flaxman AD. Conflict-related intentional injuries in Baghdad, Iraq, 2003-2014: A modeling study and proposed method for calculating burden of injury in conflict. PLoS Med 2021; 18:e1003673. [PMID: 34351908 PMCID: PMC8376016 DOI: 10.1371/journal.pmed.1003673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/19/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous research has focused on the mortality associated with armed conflict as the primary measure of the population health effects of war. However, mortality only demonstrates part of the burden placed on a population by conflict. Injuries and resultant disabilities also have long-term effects on a population and are not accounted for in estimates that focus solely on mortality. Our aim was to demonstrate a new method to describe the effects of both lives lost, and years of disability generated by a given conflict, with data from the US-led 2003 invasion and subsequent occupation of Iraq. METHODS AND FINDINGS Our data come from interviews conducted in 2014 in 900 Baghdad households containing 5,148 persons. The average household size was 5.72 persons. The majority of the population (55.8%) were between the ages of 19 and 60. Household composition was evenly divided between males and females. Household sample collection was based on methodology previously designed for surveying households in war zones. Survey questions were answered by the head of household or senior adult present. The questions included year the injury occurred, the mechanism of injury, the body parts injured, whether injury resulted in disability and, if so, the length of disability. We present this modeling study to offer an innovative methodology for measuring "years lived with disability" (YLDs) and "years of life lost" (YLLs) attributable to conflict-related intentional injuries, using the Global Burden of Disease (GBD) approach. YLDs were calculated with disability weights, and YLLs were calculated by comparing the age at death to the GBD standard life table to calculate remaining life expectancy. Calculations were also performed using Iraq-specific life expectancy for comparison. We calculated a burden of injury of 5.6 million disability-adjusted life years (DALYs) lost due to conflict-related injuries in Baghdad from 2003 to 2014. The majority of DALYs lost were attributable to YLLs, rather than YLDs, 4.99 million YLLs lost (95% uncertainty interval (UI) 3.87 million to 6.13 million) versus 616,000 YLDs lost (95% UI 399,000 to 894,000). Cause-based analysis demonstrated that more DALYs were lost to due to gunshot wounds (57%) than any other cause. Our study has several limitations. Recall bias regarding the reporting and attribution of injuries is possible. Second, we have no data past the time of the interview, so we assumed individuals with ongoing disability at the end of data collection would not recover, possibly counting more disability for injuries occurring later. Additionally, incomplete data could have led to misclassification of deaths, resulting in an underestimation of the total burden of injury. CONCLUSIONS In this study, we propose a methodology to perform burden of disease calculations for conflict-related injuries (expressed in DALYs) in Baghdad from 2003 to 2014. We go beyond previous reports of simple mortality to assess long-term population health effects of conflict-related intentional injuries. Ongoing disability is, in cross section, a relatively small 10% of the total burden. Yet, this small proportion creates years of demands on the health system, persistent limitations in earning capacity, and continuing burdens of care provision on family members.
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Affiliation(s)
- Guy W. Jensen
- University of California Davis Department of Surgery, Sacramento, California, United States of America
- * E-mail:
| | - Riyadh Lafta
- Al Mustansiriya University, College of Medicine, Baghdad, Iraq
| | - Gilbert Burnham
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Hagopian
- University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Noah Simon
- University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Abraham D. Flaxman
- University of Washington School of Public Health, Seattle, Washington, United States of America
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13
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Sterkenburg A, Van der Stelt M, Koroma A, Van Gaalen M, Van der Pols M, Grobusch M, Slump C, Maal T, Brouwers L. Quality of life of patients with 3D-printed arm prostheses in a rural area of Sierra Leone. Heliyon 2021; 7:e07447. [PMID: 34286125 PMCID: PMC8273216 DOI: 10.1016/j.heliyon.2021.e07447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In Sierra Leone, access to prostheses is limited due to absence of practical knowledge, materials, trained staff, and high cost. This paper investigates the impact of a 3D printed prosthesis on the health-related quality of life (HRQoL) in prosthesis recipients. METHODS Patients with upper extremity amputations were included in this case study from December 2018 until July 2019. Data on the HRQoL was gathered until April 2020 in Masanga Hospital, central rural Sierra Leone. At two follow-up moments the HRQoL was assessed by applying the standard EQ-5D-5L questionnaire. These two follow-up moments varied between one week and just over a year after receiving the prosthesis. A second patient questionnaire was used to assess prosthesis satisfaction. RESULTS Seven patients were included. The results of the EQ-5D-5L questionnaire show no deterioration of the HRQoL in any patient and the overall HRQoL increased by almost 20% compared to the null measurement. One patient was lost to follow up after the first re-visit. The responses to the second questionnaire indicated that patients are satisfied with the prosthesis and use it in various situations. Patients often mentioned they feel more included in society when wearing the prosthesis. One patient says wearing the prosthesis helped in accepting the amputation. As a result, enough self-confidence was experienced without the prosthesis and the patients stopped wearing the prosthesis. DISCUSSION The overall HRQoL in patients wearing a 3D-printed prosthesis increases compared to not wearing one. Assessing the HRQoL at regular intervals is important for the long-term follow-up and to safeguard sustainability and long-term success of this project. Nevertheless, defining the HRQoL is challenging due to cultural differences and misunderstandings. Therefore, the use of alternative questionnaires to define the HRQoL should be investigated. To improve and warrant long-term success, identifying long-term problems is important, and the second questionnaire accounts for this need.
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Affiliation(s)
- A.J. Sterkenburg
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - M. Van der Stelt
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - A.R. Koroma
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - M.D. Van Gaalen
- Technical Medicine, Delft University of Technology, Delft, the Netherlands
| | - M.J. Van der Pols
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - M.P. Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, Amsterdam, the Netherlands
| | - C.H. Slump
- Technical Medicine, University of Twente, Enschede, the Netherlands
| | - T.J.J. Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L. Brouwers
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Surgery Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
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van Gaalen MD, van der Stelt M, Vas Nunes JH, Brouwers L. People with amputations in rural Sierra Leone: the impact of 3D-printed prostheses. BMJ Case Rep 2021; 14:e236213. [PMID: 34127498 PMCID: PMC8204157 DOI: 10.1136/bcr-2020-236213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/03/2022] Open
Abstract
We report the case of a man with a transhumeral amputation in a rural area of Sierra Leone. The patient had fractured his humerus during a football match. Due to lack of transportation and medical centres nearby, the patient was seen by a traditional healer. Although the traditional healer expected the fractured bone to heal within 3 days, the open fracture became infected. This finally resulted in a transhumeral amputation. The patient began to have a lack of self-confidence and felt excluded from society. He could not afford a conventionally fabricated prosthesis. Fourteen years later, the patient received a lightweight three-dimensional-printed arm prosthesis developed at the Masanga Hospital. The patient was very satisfied because the prosthesis met his criteria of aesthetics and functionality. His story highlights the socioeconomic hardship of being a person with an amputation in Sierra Leone and the need for affordable technological solutions.
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Affiliation(s)
- Melissa D van Gaalen
- Technical Medicine, Delft University of Technology Faculty of Mechanical Maritime and Materials Engineering, Delft, The Netherlands
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
| | - Merel van der Stelt
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Radboud UMC 3D Lab, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Lars Brouwers
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
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Whitaker J, Harling G, Sie A, Bountogo M, Hirschhorn LR, Manne-Goehler J, Bärnighausen T, Davies J. Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey. BMJ Open 2021; 11:e045621. [PMID: 34049913 PMCID: PMC8166610 DOI: 10.1136/bmjopen-2020-045621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso. DESIGN Cross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset. SETTING Rural Burkina Faso. PARTICIPANTS 3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury. RESULTS 7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%). CONCLUSIONS Injury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- King's Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospitals, University of Heidelberg, Heidelberg, Germany
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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16
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van der Stelt M, Grobusch MP, Koroma AR, Papenburg M, Kebbie I, Slump CH, Maal TJ, Brouwers L. Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone - an observational cohort study. EClinicalMedicine 2021; 35:100874. [PMID: 34027333 PMCID: PMC8129890 DOI: 10.1016/j.eclinm.2021.100874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is a huge unmet global need for affordable prostheses. Amputations often happen in Sierra Leone due to serious infections, complex wounds, traffic accidents and delayed patient presentation to the hospital. However, purchasing a prosthesis is still beyond reach for most Sierra Leonean amputees. METHOD We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. Research was performed using questionnaires to investigate the use, participants' satisfaction, and possible complications related to the prostheses. Questionnaires were conducted prior to production of the prosthesis and five to six weeks after fitting the prosthesis. A personal short-term goal was set by the participants. FINDINGS Competitively priced and fully functional prostheses were produced locally. After six weeks, all participants were still wearing the prosthesis and six of the eight participants reached their personal rehabilitation goals. Using their prostheses, all participants were no longer in need of their crutches. INTERPRETATION We have come a step closer to the production of low-cost prostheses for low-and middle-income countries (LMICs). The goal of our project is to perform long-term follow-up and to refine our concept of 3D printed prostheses for LMICs to provide practical solutions for a global health need unmet to date. FUNDING € 15,000 was collected during a crowdfunding campaign in collaboration with the Dutch Albert Schweitzer Fund. Internship allowance for MvdS was obtained from the University of Twente. 3D-scanner, 3D-printer, and printing material were donated by Ultimaker BV and Shining 3D.
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Affiliation(s)
- Merel van der Stelt
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Masanga Hospital, Masanga, Sierra Leone
- Technical Medicine, University of Twente, Enschede, The Netherlands
- Radboudumc 3D lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin. P. Grobusch
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdul. R. Koroma
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
| | | | - Ismaila Kebbie
- National Rehabilitation Programme/Centre, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Thomas J.J. Maal
- Radboudumc 3D lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Brouwers
- Masanga Hospital, Masanga, Sierra Leone
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
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van der Stelt M, Verhulst AC, Vas Nunes JH, Koroma TAR, Nolet WWE, Slump CH, Grobusch MP, Maal TJJ, Brouwers L. Improving Lives in Three Dimensions: The Feasibility of 3D Printing for Creating Personalized Medical Aids in a Rural Area of Sierra Leone. Am J Trop Med Hyg 2020; 102:905-909. [PMID: 32100676 DOI: 10.4269/ajtmh.19-0359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this feasibility study was to investigate how a 3D printer could be put to its best use in a resource-limited healthcare setting. We have examined whether a 3D printer can contribute to making prostheses, braces, or splints for patients who underwent major limb amputation because of complex wounds, for example, due to burns and subsequent scarring, accidents, conflicts, or congenital abnormalities. During a 3-month period, we investigated the benefits of customized, 3D-printed arm prostheses, splints, and braces in Sierra Leone. Using a handheld 3D scanner and a 3D printer, patient-specific medical aids were designed, manufactured, and tested. Questionnaires regarding patient satisfaction and the functionality of the prostheses were used for a short-term follow-up. Four esthetic prostheses were designed: two prostheses of the hand, one of the forearm, and one of the entire arm. Follow-ups were conducted after 3 to 4 weeks to investigate the quality of the prostheses and to complete a patient questionnaire. Even though the prostheses primarily fulfill esthetic needs, they also exhibit some degree of functionality. In addition, four splints for hands and arms were made to prevent scar contractures after skin transplantation. Finally, a brace for a young boy with kyphoscoliosis was manufactured. The boy has accepted the brace and will be followed up in the months to come. Long-term follow-up is required to prove the sustainability of the 3D-printed brace and prosthetic arms. Further research into how to sustain and refine this project is underway.
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Affiliation(s)
- Merel van der Stelt
- Technical Medicine, University of Twente, Enschede, The Netherlands.,3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arico C Verhulst
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Throy A R Koroma
- Masanga Medical Research Unit (MMRU), Tonkolili District, Sierra Leone
| | - Wouter W E Nolet
- Masanga Medical Research Unit (MMRU), Tonkolili District, Sierra Leone
| | - Cornelis H Slump
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas J J Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Brouwers
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Bakhsh A, Aljuzair AH, Eldawoody H. An Epidemiological Overview of Spinal Trauma in the Kingdom of Saudi Arabia. Spine Surg Relat Res 2020; 4:300-304. [PMID: 33195853 PMCID: PMC7661028 DOI: 10.22603/ssrr.2019-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/02/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The World Report on Road Traffic Injury Prevention indicates that by 2020, road traffic injuries will be a major killer, accounting for half a million deaths and 15 million disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) has one of the highest rates of spinal cord injuries in the world, with 62 people injured per 1 million, and the injuries are mostly due to traffic accidents. METHODS All polytrauma patients associated with spinal injuries admitted to Prince Mohammed bin Abdul Aziz Hospital (PMAH), Riyadh, from January 2017 to June 2018, were included in this study. Patients with old spinal injuries, any previous spinal surgery, spine infection, or concomitant diagnosed malignancies or osteoporotic collapse with or without falls were excluded. All patients underwent whole-spine computed tomography scan and, in selective cases, magnetic resonance imaging of the spine. RESULTS Of the 230 patients, 90.0% were male, and 60% were in the second and third decades. Motor vehicle accidents were responsible for 83% of the cases, of which 50% of the victims were the drivers, and 80% were passengers with no seatbelt on. Nearly 50% of the spinal injuries were associated with injuries in the other body parts. Cervical spine injury accounted for 44% of the cases, followed by the lumbar spine injury. Twenty five percent of the patients presented with fixed neurologic deficit in the form of quadriplegia or paraplegia (ASIA-A). The mortality rate was 1.3%. CONCLUSIONS This study revealed that motor vehicle accidents are a major cause of spinal injuries in the KSA. One-fourth of the spinal Injuries are associated with complete spinal cord injuries. Therefore, in order to prevent lifelong disability in the young population, a nationwide program should be initiated to prevent road traffic accidents.
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Affiliation(s)
- Ahmed Bakhsh
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ali Hassan Aljuzair
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hany Eldawoody
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
- Department of Neurosurgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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19
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Hussain AMA, Lafta RK. Accidents in Iraq during the period of conflict (2003-2016). Qatar Med J 2019; 2019:14. [PMID: 31903321 PMCID: PMC6929514 DOI: 10.5339/qmj.2019.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Injuries are increasingly recognized as a major component of the global burden of disease, as they tend to affect mainly youth and are usually followed by premature death or severe disability. The longstanding conflict in Iraq has resulted in a situation of continuous violence and ongoing instability, which has in turn led to an increasing incidence of injuries and a crippled health system. Objective: To sketch a trend of non-military accidents in Iraq (road traffic accidents [RTA], falls, burns, firearm injuries, assaults by sharp objects and sexual assaults) among civilians during the last 14 years associated with the period of conflict (2003-2016). Methods: This descriptive study was conducted during the period from January 1st through to December 31st, 2017 using already available surveillance data from the Ministry of Health in Iraq. The methodology was based on measuring the incidence of each accident for the period from 2003 through 2016 and plotting it against time. Linear regression was computed to estimate the trends of the disease. Results: The rate of RTAs significantly increased between 2003 and 2016, from 1.85 to 2.9 per 1000 (p ≤ 0.01), as did accidental falls especially after 2008 (males more than females) (p ≤ 0.01). By contrast, after a peak in 2011, burns dropped significantly from 4.19 to 3.42/1000, along with firearm accidents, which fell from 2.2/1000 in 2007 to 0.39 in 2016 (p ≤ 0.01), mostly among males. Assaults with sharp objects also decreased with time to a rate of 0.47/1000 (p = 0.0001). Sexual assaults showed a significant downward sloping trend over time to p = 0.037. Conclusion: Accidents still add a burden on the already deteriorated Iraqi health system. Understanding the impact of this burden is essential to better prepare for future plans and interventions that may help improve the quality of health services.
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Affiliation(s)
- Ashraf MA Hussain
- Department of Family and Community Medicine, College of Medicine, University of Babylon, Babil, Iraq
| | - Riyadh K Lafta
- Department of Family and Community Medicine, College of Medicine, Mustansiriya University, Baghdad, Iraq; Global Health Department, University of Washington, Seattle, USA
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20
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Benchmarking Global Trauma Care: Defining the Unmet Need for Trauma Surgery in Ghana. J Surg Res 2019; 247:280-286. [PMID: 31690530 DOI: 10.1016/j.jss.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma operations/100,000 persons, providing a benchmark for trauma surgery needs. We sought to determine Ghana's annual trauma operation rate compared with this benchmark. METHODS Data on all operations performed in Ghana from June 2014 to May 2015 were obtained from representative sample of 48/124 district (first level), 8/11 regional, and 3/5 tertiary hospitals and scaled up for nationwide estimates. Trauma operations were grouped by hospital level and categorized into "essential" (most cost-effective, highest population impact) versus "other" (specialized) as per the World Bank's Disease Control Priorities Project. Ghana's annual trauma operation rate was compared with the New Zealand benchmark to quantify current met needs for trauma surgery. RESULTS About 232,776 operations were performed in Ghana; 35,797 were for trauma. Annual trauma operation rate was 134/100,000 (95% UI: 98-169), only 12% of the New Zealand benchmark. District hospitals performed 62% of all operations in the country, but performed only 38% of trauma operations. Eighty seven percentage of trauma operations were deemed "essential". Among specialized trauma operations, only open reduction and internal fixations had even modest numbers (3483 operations). Most other specialized trauma operations were rare. CONCLUSIONS Ghana has a large unmet need for operative trauma care. The low percentage of trauma operations in district hospitals indicates an even greater unmet need in rural areas. Future global surgery benchmarking should consider benchmarks for trauma and other specialties, as well as for different hospital levels.
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21
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Wichlas F, Tsitsilonis S, Guanti MD, Strada G, Deininger C. Orthopedic trauma surgeon in Sierra Leone: how to keep one's head over water. Arch Orthop Trauma Surg 2019; 139:1217-1223. [PMID: 30911828 PMCID: PMC6687693 DOI: 10.1007/s00402-019-03171-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Developing a guideline for orthopedic trauma surgeons working in civilian trauma hospitals in low-income countries. METHODS This is a retrospective data analysis in a non-governmental organizational trauma hospital in Sierra Leone, Africa. Trauma victims (282), with 349 fractures, were admitted to the hospital 10/2015-01/2016. The incidence of open and closed fractures and the use of implants were evaluated. RESULTS The most common fractures were open and closed tibial shaft fractures and closed femoral shaft fractures in adults, and closed supracondylar humerus fractures in children. The most used implants were external fixators, K-wires, and intramedullary nails. External fixators were used for open fractures, K-wires for closed fractures in children, hand and foot, and nails for closed fractures of the lower extremity in adults. Plates were used the least and mostly for fractures of the upper extremity, the proximal tibia and malleolar region in adults. The complication rate was 5.67%. CONCLUSION Surgeons in low-income country trauma hospitals should treat conservatively on outpatient basis only, to reduce the amount of stationary patients. Open fractures should be treated with external fixators, and closed fractures in children, hand and foot, with K-wires. Closed fractures in adults of the lower extremity should be nailed, and closed fractures in adults of the upper extremity can be treated with plates.
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Affiliation(s)
| | - Serafim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Michela Delli Guanti
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gino Strada
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Deininger
- Universitätsklinik für Orthopädie und Traumatologie, Müllner Hauptstraße 48, Salzburg, 5020, Austria.
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22
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Update on the management of craniomaxillofacial trauma in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2019; 27:274-279. [PMID: 31274568 DOI: 10.1097/moo.0000000000000545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings. RECENT FINDINGS Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula. SUMMARY CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.
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23
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Johnston PF, Padmanaban V, Jalloh S, Balarezo LL, Valenzuela R, Tran A, Sule H, Sifri ZC. Integrating Bleeding Control Training Into Surgical Missions in Low- and Middle-Income Countries. J Surg Res 2019; 241:53-56. [PMID: 31004873 DOI: 10.1016/j.jss.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/04/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Basic bleeding control (BCon) techniques can save lives globally but the knowledge is not widespread in low-income countries where trauma is a common cause of death. Short-term surgical missions (STSMs) are an effective route to share this public health initiative around the world. MATERIALS AND METHODS Over 2017-2018, the International Surgical Health Initiative organized STSMs to locations in Sierra Leone, Bangladesh, Peru, and Ghana. The hour-long official American College of Surgeons Basic Bleeding Control course was offered to host participants several times over the course of the mission. Data including number and size of classes, type of trainee, instructors trained, and success rate in demonstrating acquisition of core BCon principles and techniques were collected. RESULTS Over the course of four, week-long STSMs, 748 people were successfully trained in BCon over 27 sessions, with an average of 28 trainees and up to four instructors per class. One-hundred percent of trainees demonstrated acquisition of required skills proficiency. Trainees included health care workers and those in public security roles. CONCLUSIONS Concurrent with a short-term surgical mission, a substantial number of health care providers and would-be bystanders can be trained in BCon in countries most impacted by trauma. Local instructors can be trained to teach BCon independently to sustain the initiative. STSMs are a feasible modality to teach bleeding control techniques to an international audience that does not have rapid access to effective prehospital care.
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Affiliation(s)
- Peter F Johnston
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Samba Jalloh
- College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | | | - Rolando Valenzuela
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Ashley Tran
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Harsh Sule
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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24
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Pereira LDDS, Bassi E, Tomazini BM, Jesus VLM, Tierno PFGMM, Novo FDCF, Malbouisson LM, Utiyama EM. Sternal fractures in a level III trauma intensive care unit. ACTA ACUST UNITED AC 2019; 46:e2059. [PMID: 30916208 DOI: 10.1590/0100-6991e-20192059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. METHODS retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. RESULTS 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. CONCLUSION sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.
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Affiliation(s)
- Leonardo Dantas da Silva Pereira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Estevão Bassi
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Bruno Martins Tomazini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Vinicius Luiz Menezes Jesus
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | | | - Fernando Da Costa Ferreira Novo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
| | - Luiz Marcelo Malbouisson
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Anestesiologia, São Paulo, SP, Brasil
| | - Edivaldo Massazo Utiyama
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Divisão de Cirurgia Geral e Trauma, São Paulo, SP, Brasil
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Gathecha GK, Ngaruiya C, Mwai W, Kendagor A, Owondo S, Nyanjau L, Kibogong D, Odero W, Kibachio J. Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey. BMC Public Health 2018; 18:1222. [PMID: 30400906 PMCID: PMC6219001 DOI: 10.1186/s12889-018-6061-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Injuries are becoming an increasingly important public health challenge globally, and are responsible for 9% of deaths. Beyond their impact on health and well-being, fatal and non-fatal injuries also affect social and economic development for individuals concerned. Kenya has limited data on the magnitude and factors associated with injuries. This study sought to determine the magnitude and risk factors for injuries in Kenya and to identify where the largest burden lies. METHODS A national population-based household survey was conducted from April-June 2015 among adults age 18-69 years. A three-stage cluster sample design was used to select clusters, households and eligible individuals based on WHO guidelines. We estimated the prevalence of injuries, identified factors associated with injuries and the use of protective devices/practices among road users. Multivariate logistic regression was used to identify potential factors associated with injuries. RESULTS A total of 4484 adults were included in the study. Approximately 15% had injuries from the past 12 months, 60.3% were males. Four percent of the respondents had been injured in a road traffic crash, 10.9% had experienced unintentional injuries other than road traffic injuries while 3.7% had been injured in violent incidents. Among drivers and passengers 12.5% reported always using a seatbelt and 8.1% of the drivers reported driving while drunk. The leading causes of injuries other than road traffic crashes were falls (47.6%) and cuts (34.0%). Males (p = 0.001), age 18-29 (p < 0.05) and smokers (p = 0.001) were significantly more likely to be injured in a road traffic crash. A higher social economic status (p = 0.001) was protective against other unintentional injuries while students had higher odds for such types of injuries. Heavy episodic drinking (p = 0.001) and smoking (p < 0.05) were associated with increased likelihood of occurrence of a violent injury. CONCLUSIONS Our study found that male, heavy episodic drinkers, current smokers and students were associated with various injury types. Our study findings highlight the need to scale up interventions for injury prevention for specific injury mechanisms and target groups. There is need for sustained road safety mass media campaigns and strengthened enforcement on helmet wearing, seatbelt use and drink driving.
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Affiliation(s)
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT USA
| | - Wilfred Mwai
- Division of Non Communicable Diseases, Ministry of Heath, Nairobi, Kenya
| | - Ann Kendagor
- Division of Non Communicable Diseases, Ministry of Heath, Nairobi, Kenya
| | - Scholastica Owondo
- Division of Non Communicable Diseases, Ministry of Heath, Nairobi, Kenya
| | - Loise Nyanjau
- Division of Non Communicable Diseases, Ministry of Heath, Nairobi, Kenya
| | - Duncan Kibogong
- Directorate of Road Safety, National Transport and Safety Authority, Nairobi, Kenya
| | - Wilson Odero
- Faculty of Medicine, Maseno University, Kisumu, Kenya
| | - Joseph Kibachio
- Division of Non Communicable Diseases, Ministry of Heath, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
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Mwandri MB, Hardcastle TC. Burden, Characteristics and Process of Care Among the Pediatric and Adult Trauma Patients in Botswana's Main Hospitals. World J Surg 2018; 42:2321-2328. [PMID: 29450701 DOI: 10.1007/s00268-018-4528-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower-middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends 'Essential Trauma Care' in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system. METHOD Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults. Data are presented using descriptive statistics. RESULTS The proportion of trauma ranged between 6 and 10% of Emergency Department cases. Pediatrics constituted 19%, and 59% of all patients were male. The median age was 28 years [IQR 17-39] and 8 years [IQR 4-11] for adults and pediatrics, respectively. The leading causes of injuries were: falls in pediatrics (55%) and interpersonal violence in the adults (34%), followed by RTC in both children (20%) and adults (30%). The public inter-hospital vehicles transported 77% of pediatrics and 69% of adults, while formal ambulance transported only 9% of pediatrics and 22% of adults. The median Emergency Department waiting time for pediatrics was 187 min [IQR 102-397] and for adults was 208 min [IQR 100-378]: Most were triaged as non-urgent (70% pediatrics and 72% adults), and the majority were discharged (84% pediatrics and 76% adults). CONCLUSION The Emergency Department workload of injuries is notably high, with differing mechanisms of injury and transport modes between pediatrics and adults: Waiting time is severely prolonged for urgent and critical patients. Diagnoses, triage categories and patients disposition were similar.
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Affiliation(s)
- Michael B Mwandri
- Department Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa. .,Department of Surgery, Kilimanjaro Christian Medical University College, P.O. Box 3010, Moshi, Tanzania.
| | - Timothy C Hardcastle
- Department Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.,Trauma Service and Trauma ICU, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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27
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Varela C, Young S, Groen R, Banza L, Mkandawire NC, Viste A. Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey. Malawi Med J 2018; 29:231-236. [PMID: 29872512 PMCID: PMC5811994 DOI: 10.4314/mmj.v29i3.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Noncommunicable diseases, such as surgical conditions have received little attention from public health planners in low income countries (LIC) like Malawi. Though increasingly recognised as a growing global health problem, the burden of surgical pathologies and access to surgical care has not been adequately identified in many LIC. Information on the spectrum and burden of surgical disease in Malawi is important to uncover the unmet need for surgery and for planning of the National Health Service. Methods This was a multistage random cluster sampling national survey. Households were selected from clusters using probability proportional to size method. 1448 households and 2909 interviewees were analysed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used to collect data. This electronic tablet based questionnaire tool included general information and a dual personalised head to toe inquiry on surgical conditions. The general information included number of household members, and inquired on any death within the past twelve months, and if any of the deaths in the family had a suspected surgical condition leading to that death. Data was collected by specially trained third year medical students. Results Out of 1480 selected households, 1448 (98%) agreed to participate, with 2909 interviewed individuals included in the study. The median household size was 6 individuals (range 1 – 47). Median age of interviewed persons was 35 years (range 0.25 – 104 years). 1027 out of 2909 (35%) of the interviewed people reported to be living with a condition requiring surgical consultation or intervention, whereas 146 of 616 (24%) of the total deaths reported to have occurred in the preceding 12 months were reported to have died from a surgically related condition. Most individuals did not seek health care due to lack of funds for transportation to the health facility. Only 3.1% of those that reported a surgical condition had surgical intervention. Conclusions There is a large unmet need for surgical care in Malawi. A third of the population is living with a condition needing surgical consultation or intervention, and a quarter of all deaths are potentially avoidable with surgery. Urgent scale up of surgical services and training are needed to reduce this huge gap in public health planning in the country.
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Affiliation(s)
- Carlos Varela
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway
| | - Sven Young
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Obstetrics and Gynaecology, Alaska Native Medical Center, Anchorage, Alaska, USA
| | - Leonard Banza
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Asgaut Viste
- Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway.,Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
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Bundu I, Lowsby R, Vandy HP, Kamara SP, Jalloh AM, Scott CO, Beynon F. The burden of trauma presenting to the government referral hospital in Freetown, Sierra Leone: An observational study. Afr J Emerg Med 2018; 9:S9-S13. [PMID: 30976495 PMCID: PMC6440925 DOI: 10.1016/j.afjem.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/19/2018] [Accepted: 07/20/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Trauma accounts for a significant proportion of the global burden of disease, with highest mortality rates seen in Africa. This epidemic is predicted to increase with urbanisation and an aim of the Sustainable Development Goals is to reduce deaths and trauma caused by road accidents. Data available on urban trauma in Sierra Leone is limited. METHODS We conducted a retrospective observational study of trauma and injury related presentations to the emergency centre (EC) of Connaught Hospital, the principal adult tertiary referral centre in Freetown, Sierra Leone between January and March 2016. Patient demographics are described with mechanism of injury. Additional data on length of stay and surgical procedures were recorded for admissions to the trauma ward. RESULTS During the 3-month period, a total of 340 patients with injury presented to the EC, accounting for 11.6% of total attendances and 68% of adult surgical admissions. The majority were male (66%) and mean age was 26 years (IQR 15-40). The proportion of trauma presentations were higher in the evening and at weekends and 41% of patients were triaged as emergency or very urgent cases. Road traffic accidents were the most frequent cause of injury (55%) followed by falls (17%) and assaults (14%). Burns were more common in children. Head and lower limbs were the most commonly injured body parts and a minority of patients underwent surgical procedures. Median length of stay for adult patients was 4.5 days (IQR 2-11) and 7 days (IQR 4-14) for children. DISCUSSION Injury accounts for a high burden of disease at Connaught Hospital and consumes a significant proportion of EC and hospital resources. Efforts should be directed towards strengthening the pre-hospital and emergency trauma systems with accurate, formal data collection as well as targeting injury prevention initiatives and improving road safety to reduce morbidity and mortality.
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Affiliation(s)
- Ibrahim Bundu
- Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Richard Lowsby
- King’s Sierra Leone Partnership, King’s Centre for Global Health, King's College London and King’s Health Partners, UK
| | - Hassan P. Vandy
- Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Suleiman P. Kamara
- Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Abdul Malik Jalloh
- Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Christella O.S. Scott
- Department of Surgery, Connaught Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Fenella Beynon
- King’s Sierra Leone Partnership, King’s Centre for Global Health, King's College London and King’s Health Partners, UK
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Diamond MB, Dalal S, Adebamowo C, Guwatudde D, Laurence C, Ajayi IO, Bajunirwe F, Njelekela MA, Chiwanga F, Adami HO, Nankya-Mutyoba J, Kalyesubula R, Reid TG, Hemenway D, Holmes MD. Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study. Inj Prev 2017; 24:272-278. [PMID: 29118002 DOI: 10.1136/injuryprev-2016-042254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/18/2017] [Accepted: 06/28/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Injury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA). METHODS A common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury. RESULTS A total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury. CONCLUSION At baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.
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Affiliation(s)
- Megan B Diamond
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shona Dalal
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Clement Adebamowo
- Institute of Human Virology, Abuja, Nigeria.,Greenebaum Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David Guwatudde
- Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda
| | - Carien Laurence
- Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
| | - Ikeoluwapo O Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Marina A Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Faraja Chiwanga
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joan Nankya-Mutyoba
- Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda
| | | | - Todd G Reid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Hemenway
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Michelle D Holmes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, Juillard C. Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon. PLoS One 2017; 12:e0180784. [PMID: 28723915 PMCID: PMC5516986 DOI: 10.1371/journal.pone.0180784] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of trauma in Cameroon is limited. Regular, prospective injury surveillance can address the shortcomings of existing hospital administrative logs and medical records. This study aims to characterize trauma as seen at the emergency department (ED) of Limbe Regional Hospital (LRH) and assess the completeness of data obtained by a trauma registry. METHODS AND FINDINGS From January 2008 to October 2013, we prospectively captured data on injured patients using a strategically designed, context-relevant trauma registry instrument. Indicators around patient demographics, injury characteristics, delays in accessing care, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. About 5,617 patients, aged from 0.5-95years (median age of 26 years), visited the LRH ED with an injury; 67% were male. Students (27%) were the most affected occupation category. Road traffic injuries (RTIs) (56%), assault (22%), and domestic injuries (13%) were the leading causes of injury. Two-thirds of RTIs were motorcycle-related. Working in transportation (AOR 4.42, p<0.001) and law enforcement (AOR 1.73, p = 0.004) were significant predictors of having a RTI. The trauma registry showed a significant improvement in completeness of all data (p<0.001) and it improved over time compared with previous administrative records. However, proportions of missing data still ranged from 0.5% to 8.2% and involved respiratory rate or Glasgow Coma scale. CONCLUSIONS Implementation of a context-appropriate trauma registry in resource-constrained settings is feasible. Providing valuable, high-quality data, the trauma registry can inform trauma care quality improvement efforts and policy development. Study findings indicate the need for injury prevention interventions and policies that will prioritize high-risks groups, such as those aged 20-29 years, and those in occupations requiring frequent road travel. The high incidence of motorcycle-related injuries is concerning and calls for a proactive solution.
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Affiliation(s)
- Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Obieze C. Nwanna-Nzewunwa
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Vincent Verla Siysi
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Isabelle Feldhaus
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Rochelle Dicker
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
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Hoque DME, Islam MI, Sharmin Salam S, Rahman QSU, Agrawal P, Rahman A, Rahman F, El-Arifeen S, Hyder AA, Alonge O. Impact of First Aid on Treatment Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and Demographic Census. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070762. [PMID: 28704972 PMCID: PMC5551200 DOI: 10.3390/ijerph14070762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/03/2017] [Accepted: 07/09/2017] [Indexed: 11/16/2022]
Abstract
Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.
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Affiliation(s)
- Dewan Md Emdadul Hoque
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Md Irteja Islam
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Shumona Sharmin Salam
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Priyanka Agrawal
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Aminur Rahman
- Centre for Injury Prevention and Research, House #B-162, Road #23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Fazlur Rahman
- Centre for Injury Prevention and Research, House #B-162, Road #23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Shams El-Arifeen
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Pascual-Marrero A, Ramos-Meléndez EO, García-Rodríguez O, Morales-Quiñones JE, Rodríguez-Ortiz P. Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011. Int J Inj Contr Saf Promot 2017; 25:14-22. [PMID: 28417686 DOI: 10.1080/17457300.2017.1310738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002-2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07-1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49-2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20-3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23-1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.
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Affiliation(s)
- Annette Pascual-Marrero
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico
| | | | | | - José E Morales-Quiñones
- c Department of Biology , Rio Piedras Campus , University of Puerto Rico , San Juan , Puerto Rico
| | - Pablo Rodríguez-Ortiz
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico.,b Puerto Rico Trauma Hospital , San Juan , Puerto Rico
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Sex Differences in Civilian Injury in Baghdad From 2003 to 2014: Results of a Randomized Household Cluster Survey. Ann Surg 2017; 267:1173-1178. [PMID: 28151803 DOI: 10.1097/sla.0000000000002140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning. BACKGROUND Reliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women. METHODS A 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship. RESULTS We surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ± 21.3 vs 27 ± 16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011). CONCLUSIONS Women experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.
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Gupta S, Gupta SK, Devkota S, Ranjit A, Swaroop M, Kushner AL, Nwomeh BC, Victorino GP. Fall Injuries in Nepal: A Countrywide Population-based Survey. Ann Glob Health 2016; 81:487-94. [PMID: 26709280 DOI: 10.1016/j.aogh.2015.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause of unintentional injury-related deaths after road traffic injuries. More than 80% of fall-related fatalities occur in low- and middle-income countries. Data from low-income South Asian countries like Nepal are lacking, particularly at the population level. The aim of this study was to provide an estimate of fall-injury prevalence and the number of fall injury-related deaths countrywide in Nepal and to describe the epidemiology of fall injuries in Nepal at the community level. METHODS A countrywide cross-sectional study was performed in 15 of the 75 districts in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. The SOSAS survey gathers data in 2 sections: demographic data, including the household's access to health care and recent deaths in the household, and assessment of a representative spectrum of surgical conditions, including injuries. Data was collected regarding an individuals' experience of injury including road traffic injuries, falls, penetrating trauma, and burns. Data included anatomic location, timing of injury, and whether health care was sought. If health care was not sought, the reason for barrier to care was included. Descriptive statistics were used to analyze the data. RESULTS Of 2695 individuals from 1350 households interviewed, 141 reported injuries secondary to falls (5.2%; 95% confidence interval [CI], 4.4%-6.1%), with a mean age of 30.7 years; 58% were male. Falls represented 37.2% of total injuries (n = 379) reported (95% CI, 32.3%-42.3%). Twelve individuals who suffered from a fall injury were unable to access surgical care (8.5%; 95% CI, 4.5%-14.4%). Reasons for barrier to care included no money for health care (n = 3), facility/personnel not available (n = 7), and fear/no trust (n = 2). Of the 80 recent deaths reported, 7 were due to fall injury (8.8%; 95% CI, 3.6%-17.2%), and patients had a mean age of 46 years (SD 22.8). Surgical care was not delivered to those who died for the following reasons: no time (n = 4), facility/personnel not available (n = 1), fear/no trust (n = 1), and no need (n = 1). CONCLUSION The Nepal SOSAS study provides countrywide, population-based data on fall-injury prevalence in Nepal and has identified falls as a crucial public health concern. These data highlight persistent barriers to access to care for the injured and the need to improve trauma care systems in developing countries such as Nepal.
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Affiliation(s)
- Shailvi Gupta
- University of California, San Francisco - East Bay, Department of Surgery, Surgeons OverSeas, Oakland, CA.
| | | | - Sagar Devkota
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Anju Ranjit
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mamta Swaroop
- Division of Trauma and Critical Care, Feinberg School of MEdicine, Chicago, IL
| | - Adam L Kushner
- Department of International Health and Surgeons OverSeas, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Benedict C Nwomeh
- Department of Pediatric Surgery and Surgeons OverSeas, Nationwide Children's Hospital, Columbus, OH
| | - Gregory P Victorino
- Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA
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Rwanda's Model Prehospital Emergency Care Service: A Two-year Review of Patient Demographics and Injury Patterns in Kigali. Prehosp Disaster Med 2016; 31:614-620. [PMID: 27655172 DOI: 10.1017/s1049023x16000807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Injury is responsible for nearly five million annual deaths worldwide, and nearly 90% of these deaths occur in low- and middle-income countries (LMICs). Reliable clinical data detailing the epidemiology of injury are necessary for improved care delivery, but they are lacking in these regions. METHODS A retrospective review of the Service d'Aide Medicale Urgente (SAMU; Kigali, Rwanda) prehospital database for patients with traumatic injury-related conditions from December 2012 through November 2014 was conducted. Chi-squared analysis, binomial probability test, and student's t-test were used, where appropriate, to describe patient demographics, injury patterns, and temporal and geographic trends of injuries. RESULTS In the two-year period, 3,357 patients were managed by SAMU for traumatic injuries. Males were 76.5% of the study population, and the median age of all injured patients was 29 years (IQR=23-35). The most common causes of injury were road traffic crashes (RTCs; 73.4%), stabbings/cuts (11.1%), and falls (9.4%), and the most common anatomic regions injured were the head (55.7%), lower (45.0%) extremities, and upper (27.0%) extremities. Almost one-fourth of injured patients suffered a fracture (24.9%). The most common mechanism of injury for adults was motorcycle-related RTCs (61.4%), whereas children were more commonly injured as pedestrians (59.8%). Centrally located sectors within Kigali represented common areas for RTCs. CONCLUSIONS These data support the call for focused injury prevention strategies, some of which already are underway in Rwanda. Further research on care processes and clinical outcomes for injured patients may help identify avenues for improved care delivery. Enumah S , Scott JW , Maine R , Uwitonze E , Nyinawankusi JD , Riviello R , Byiringiro JC , Kabagema I , Jayaraman S . Rwanda's model prehospital emergency care service: a two-year review of patient demographics and injury patterns in Kigali. Prehosp Disaster Med. 2016;31(6):614-620.
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Kazerooni Y, Gyedu A, Burnham G, Nwomeh B, Charles A, Mishra B, Kuah SS, Kushner AL, Stewart BT. Fires in refugee and displaced persons settlements: The current situation and opportunities to improve fire prevention and control. Burns 2016; 42:1036-1046. [PMID: 26818955 PMCID: PMC4958610 DOI: 10.1016/j.burns.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to describe the burden of fires in displaced persons settlements and identify interventions/innovations that might address gaps in current humanitarian guidelines. METHODS We performed a systematic review of: (i) academic and non-academic literature databases; and (ii) guidelines from leading humanitarian agencies/initiatives regarding fire prevention/control. RESULTS Of the 1521 records retrieved, 131 reports described settlement fires in 31 hosting countries since 1990. These incidents resulted in 487 deaths, 790 burn injuries, displacement of 382,486 individuals and destruction of 50,509 shelters. There was a 25-fold increase in the rate of settlement fires from 1990 to 2015 (0.002-0.051 per 100,000 refugees, respectively). Only 4 of the 15 leading humanitarian agencies provided recommendations about fire prevention/control strategies. Potentially useful interventions/innovations included safer stoves (e.g. solar cookers) and fire retardant shelter materials. CONCLUSION The large and increasing number of fires in displaced persons settlements highlights the need to redress gaps in humanitarian fire prevention/control guidelines. The way forward includes: (i) developing consensus among aid agencies regarding fire prevention/control strategies; (ii) evaluating the impact of interventions/innovations on the burden of fires; and (iii) engaging agencies in a broader discussion about protecting camp residents from armed groups.
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Affiliation(s)
- Yasaman Kazerooni
- College of Medicine, Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA.
| | - Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Benedict Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, 700 Childrens Dr, Columbus, OH 43205, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Brijesh Mishra
- Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, King Georges Medical University, Shah Mina Road Chowk, Lucknow, Uttar Pradesh 226003, India
| | - Solomon S Kuah
- Emergency Response Team, International Rescue Committee, 122 East 42nd Street, New York, NY 10168, USA
| | - Adam L Kushner
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA; Surgeons OverSeas (SOS), 504 E. 5th St., Suite 3E, New York, NY 10009, USA; Department of Surgery, Columbia University, 630 W. 168th St., New York, NY 10032, USA
| | - Barclay T Stewart
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA 98195-6410, USA
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Backlog and burden of fractures in Sierra Leone and Nepal: Results from nationwide cluster randomized, population-based surveys. Int J Surg 2016; 33 Pt A:49-54. [PMID: 27450628 DOI: 10.1016/j.ijsu.2016.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e., a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or premature death; DALYs) in Sierra Leone and Nepal. METHODS Data from nationwide, cluster-randomized, community-based surveys of surgical need in Sierra Leone and Nepal were used to model the incidence and prevalence of fractures stratified by met and unmet needs. DALYs incurred from treated and untreated fractures were estimated. Additionally, the investment necessary to eliminate avertable incident fracture DALYs was modeled through 2025 using published cost per DALY averted estimates. RESULTS The incidence of treated and untreated fractures in Sierra Leone was 570 and 1004 fractures per 100,000 persons, respectively. There could be more than 2 million avertable fracture DALYs by 2025 in Sierra Leone and 2.5 million in Nepal requiring an estimated US$ 4,049,932 (range US$ 2,011,500-6,088,364) and US$ 4,962,402 (range US$ 2,464,701-7,460,103) to address this excess burden, respectively. CONCLUSION This study identified a significant burden of untreated fractures in both countries, and an opportunity to avert more than 4.5 million DALYs in 10 years in a cost-effective manner. Prioritizing funding mechanisms for orthopaedic care and implants should be considered given the large burden of untreated fractures found in both countries and the long-term savings and functional benefit from properly treated fractures.
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Clausen T, Martinez P, Towers A, Greenfield T, Kowal P. Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 9:125-32. [PMID: 27257385 PMCID: PMC4878716 DOI: 10.4137/sart.s23549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/21/2016] [Accepted: 02/28/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies. METHODS Data from more than 37,000 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors. RESULTS During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (0.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men. CONCLUSIONS The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.
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Affiliation(s)
- Thomas Clausen
- Norwegian Centre for Addiction Research; University of Oslo, Norway.; Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Priscilla Martinez
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.; University of California, Berkeley, CA, USA
| | - Andy Towers
- School of Public Health, Massey University, Palmerston North, New Zealand
| | - Thomas Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.; Core Faculty, Department of Psychiatry, Clifford Attkisson Clinical Services Research Program, University of California San Francisco, San Francisco, CA, USA
| | - Paul Kowal
- World Health Organization Study on Global AGEing and Adult Health (SAGE), Geneva, Switzerland.; Research Centre for Gender, Health and Ageing, University of Newcastle, NSW, Australia
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Stewart BT, Lafta R, Cherewick M, Esa Al Shatari SA, Flaxman AD, Hagopian A, Galway LP, Takaro TK, Burnham G, Kushner AL, Mock C. Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey. Inj Prev 2016; 22:321-7. [DOI: 10.1136/injuryprev-2015-041707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/14/2016] [Indexed: 11/04/2022]
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Stewart BT, Lafta R, Shatari SAEA, Cherewick M, Flaxman A, Hagopian A, Burnham G, Kushner AL. Fall injuries in Baghdad from 2003 to 2014: Results of a randomised household cluster survey. Injury 2016; 47:244-9. [PMID: 26626808 PMCID: PMC4698051 DOI: 10.1016/j.injury.2015.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad. METHODS A two-stage, cluster randomised, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship. RESULTS Nine hundred households totaling 5148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15-64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30-8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%). CONCLUSION Falls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abraham Flaxman
- Department of Global Health, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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Stewart BT, Lafta R, Esa Al Shatari SA, Cherewick M, Burnham G, Hagopian A, Galway LP, Kushner AL. Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey. Burns 2015; 42:48-55. [PMID: 26526376 DOI: 10.1016/j.burns.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. METHODS A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. RESULTS Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. CONCLUSION Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Lindsay P Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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Lafta R, Al-Shatari S, Cherewick M, Galway L, Mock C, Hagopian A, Flaxman A, Takaro T, Greer A, Kushner A, Burnham G. Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey. PLoS One 2015; 10:e0131834. [PMID: 26252879 PMCID: PMC4529175 DOI: 10.1371/journal.pone.0131834] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/06/2015] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad. Methods Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded. Findings There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period. Interpretation Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.
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Affiliation(s)
- Riyadh Lafta
- Al Munstansiriya University, College of Medicine, Baghdad, Iraq
| | - Sahar Al-Shatari
- Human Development and Training Center, Ministry of Health, Baghdad, Iraq
| | - Megan Cherewick
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lindsay Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Charles Mock
- Harborview Injury Prevention and Research Canter, University of Washington, Seattle, Washington, United States of America
| | - Amy Hagopian
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Abraham Flaxman
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Tim Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anna Greer
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Adam Kushner
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gilbert Burnham
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: “Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage”—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg 2015; 39:2115-25. [DOI: 10.1007/s00268-015-3153-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.
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Affiliation(s)
- Jayanth Paniker
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Department of Orthopaedics, Countess of Chester Hospital Liverpool Road Chester
CH2 1UL UK
| | - Simon Matthew Graham
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Department of Orthopaedics, Countess of Chester Hospital Liverpool Road Chester
CH2 1UL UK
| | - James William Harrison
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Department of Orthopaedics, Countess of Chester Hospital Liverpool Road Chester
CH2 1UL UK
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Gupta S, Wong EG, Nepal S, Shrestha S, Kushner AL, Nwomeh BC, Wren SM. Injury prevalence and causality in developing nations: Results from a countrywide population-based survey in Nepal. Surgery 2015; 157:843-9. [PMID: 25934021 DOI: 10.1016/j.surg.2014.12.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/18/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic injury affects nearly 5.8 million people annually and causes 10% of the world's deaths. In this study we aimed to estimate injury prevalence, to describe risk-factors and mechanisms of injury, and to estimate the number of injury-related deaths in Nepal, a low-income South Asian country. METHODS A cluster randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in Nepal in 2014. Questions were structured anatomically and designed around a representative spectrum of operative conditions. Two-stage cluster sampling was performed: 15 of 75 districts were chosen randomly proportional to population; within each district, after stratification for urban and rural populations, 3 clusters were randomly chosen. Injury-related results were analyzed. RESULTS A total of 1,350 households and 2,695 individuals were surveyed verbally, with a response rate of 97%. A total of 379 injuries were reported in 354 individuals (13.1%, 95% confidence interval 11.9-14.5%), mean age of 32.6. The most common mechanism of injury was falls (37.5%), road traffic injuries (19.8%), and burns (14.2%). The most commonly affected anatomic site was the upper extremity (42.0%). Of the deaths reported in the previous year, 16.3% were injury-related; 10% of total deaths may have been averted with access to operative care. CONCLUSION This study provides baseline data on the epidemiology of traumatic injuries in Nepal and is the first household-based countrywide assessment of injuries in Nepal. These data provide valuable information to help advise policymakers and government officials for allocation of resources toward trauma care.
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Affiliation(s)
- Shailvi Gupta
- University of California San Francisco, East Bay, Oakland, CA; Surgeons Overseas, New York, NY.
| | - Evan G Wong
- McGill University Centre for Global Surgery, Montreal, Quebec, Canada; Surgeons Overseas, New York, NY
| | | | - Sunil Shrestha
- Department of Surgery, Nepal Medical College, Sinamangal, Kathmandu, Nepal
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons Overseas, New York, NY
| | - Benedict C Nwomeh
- Nationwide Children's Hospital, Columbus, OH; Surgeons Overseas, New York, NY
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Bailey MS, Beaton K, Bowley D, Eardley W, Hunt P, Johnson S, Round J, Tarmey NT, Williams A. Bending the curve: force health protection during the insertion phase of the Ebola outbreak response. J ROY ARMY MED CORPS 2015; 162:191-7. [PMID: 26036821 DOI: 10.1136/jramc-2014-000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/05/2015] [Indexed: 11/03/2022]
Abstract
After >10 years of enduring operations in Iraq and Afghanistan, Defence Strategic Direction is returning to a contingency posture. As the first post-Afghanistan operation, in September 2014, a UK Joint Inter-Agency Task Force deployed to Sierra Leone in response to the Ebola virus disease (EVD) epidemic in West Africa. The aims were expanding treatment capacity, assisting with training and supporting host nation resilience. The insertion phase of this deployment created a unique set of challenges for force health protection. In addition to the considerable risk of tropical disease and trauma, deployed personnel faced the risks of working in an EVD epidemic. This report explores how deployed medical assets overcame the difficulties of mounting a short-notice contingent operation in a region of the world with inherent major climatic and health challenges.
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Affiliation(s)
- Mark S Bailey
- Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - K Beaton
- Headquarters 2nd Medical Brigade, York, UK
| | - D Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - W Eardley
- Department of Orthopaedics, James Cook University Hospital, Middlesbrough, UK Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - P Hunt
- Emergency Department, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - S Johnson
- Garrison Medical Centre, Catterick Garrison, North Yorkshire, UK
| | - J Round
- Anaesthetics & Critical Care, James Cook University Hospital, Middlesbrough, UK
| | - N T Tarmey
- Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
| | - A Williams
- Department of Cardiology, Royal Gwent Hospital, Newport, United Kingdom
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What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews. Clin Orthop Relat Res 2015; 473:2120-30. [PMID: 25795030 PMCID: PMC4419000 DOI: 10.1007/s11999-015-4254-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries. PURPOSE We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. MATERIALS Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. RESULTS We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. CONCLUSIONS The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.
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Population-based incidence and cost of non-fatal injuries in Iran: a consistent under-recognized public health concern. Public Health 2015; 129:483-92. [DOI: 10.1016/j.puhe.2015.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 11/21/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022]
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Yadollahi M, Paydar S, Sabetianfard Jahromi G, Khalili H, Etemadi S, Abbasi H, Bolandparvaz S. Types and causalities in dead patients due to traumatic injuries. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e26028. [PMID: 25798419 PMCID: PMC4360604 DOI: 10.5812/atr.26028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/28/2014] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
Background: Trauma constitutes a major public health problem in our country and contributes significantly to unacceptably high morbidity and mortality. Objectives: This study aimed to evaluate the epidemiology of trauma in dead patients referred to Shahid Rajaee Trauma Hospital, Shiraz, Iran. Patients and Methods: In a cross-sectional study, all patients with trauma admitted to our center were enrolled between March 2011 and February 2012. Age, gender, months of referring, causalities, and injured body parts of the victims were extracted from the data registry and analyzed. Results: A total of 9113 patients, including 7163 (78.6%) males and 1950 (21.4%) females were evaluated. Among them, 479 patients (5.3%) had died. There was a significant difference between the age of alive and dead patients (35.70 ± 0.18 and 45.44 ± 1.01 years, respectively (P < 0.001)). In addition, dead men had significantly higher percentage than alive men (83.7% and 78.3%, respectively, P = 0.005). The highest percentages of men and women who referred to our center and died were in September. Crashing by car had the most frequency of dead (247 cases) in referred patients and motorcycle accident, stabbing, and falling related injuries with 67, 36 and 26 dead cases were in the next ranks. Thorax injury had the most frequency between dead patients (53.2% of all dead) and the intracranial injury and trauma to extremities altogether were in the next ranks, which constituted more than 18.8% of all dead. Conclusions: Our data demonstrated that car and motorcycle accidents are the most important cause of trauma and thorax trauma had the most frequency among dead patients. Epidemiological evaluations and preventive measures such as this study should be conducted to provide valuable data.
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Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Hosseinali Khalili
- Department of Neurosurgery, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Samie Etemadi
- Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hamidreza Abbasi
- Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Shahram Bolandparvaz
- Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Shahram Bolandparvaz, Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7116364001, E-mail:
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Elliott IS, Groen RS, Kamara TB, Ertl A, Cassidy LD, Kushner AL, Gosselin RA. The burden of musculoskeletal disease in Sierra Leone. Clin Orthop Relat Res 2015; 473:380-9. [PMID: 25344406 PMCID: PMC4390972 DOI: 10.1007/s11999-014-4017-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal disease is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in developing countries are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure the incidence and prevalence of surgically treatable conditions, including musculoskeletal conditions, in patients in low- and middle-income countries, and was administered in the West African nation of Sierra Leone in 2012. PURPOSE We attempted to quantify the burden of potentially treatable musculoskeletal conditions in patients in Sierra Leone. METHODS A cross-sectional two-stage cluster-based survey was performed in Sierra Leone using the SOSAS. Two individuals from each randomly selected household underwent a verbal head to toe examination. The musculoskeletal-related questions from the SOSAS survey in Sierra Leone were analyzed to determine the prevalence of musculoskeletal problems in the study population. Prevalence is reported as the number of respondents with a musculoskeletal problem now and number of respondents with a musculoskeletal problem during the past year. Respondents had "no need" for care, they "received care", or they faced a barrier that prevented them from receiving care. RESULTS One thousand eight hundred seventy-five households were targeted, with 1843 undergoing the survey, which yielded 3645 individual respondents. Of the individual respondents, 462 (n=3645; 12.6% of total; 95% CI, 12%-13%) had a traumatic musculoskeletal problem during the past year, and 236 (n=3645; 6% of total; 95% CI, 5%-7%) respondents had a musculoskeletal problem of nontraumatic etiology. Of respondents with either a traumatic or nontraumatic musculoskeletal problem, 359 (n=562; 63.9% of total; 95% CI, 59.5-68.3%) needed care but were unable to receive it with the major barrier reported as financial. CONCLUSION Resource allocation decisions in global health are made based on burden of disease data in low- and middle-income countries. The data provided here for Sierra Leone may offer some generalizable insight into the scope of the burden of musculoskeletal disease for low- and middle-income countries, especially in Sub-Saharan Africa, and provide concrete evidence that musculoskeletal health should be included in the global health discussion. However, there may be important differences across countries in this region, and further study to elucidate these differences seems critical given the large burden of disease and the limited resources available in these regions to manage it.
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Affiliation(s)
- Iain S. Elliott
- University of Florida, Gainesville, FL USA ,Institute for Global Orthopaedics and Traumatology, San Francisco General Hospital, University of California at San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA
| | - Reinou S. Groen
- Surgeons OverSeas (SOS), New York, NY USA ,Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD USA
| | - Thaim B. Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Allison Ertl
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI USA
| | - Laura D. Cassidy
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI USA
| | - Adam L. Kushner
- Surgeons OverSeas (SOS), New York, NY USA ,Department of Surgery, Columbia University, New York, NY USA ,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Richard A. Gosselin
- Institute for Global Orthopaedics and Traumatology, San Francisco General Hospital, University of California at San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110 USA ,School of Public Health, University of California, Berkeley, Berkeley, CA USA
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