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Takoutsing BD, Endalle G, Senyuy WP, Celestin BM, Kwasseu GK, Tanyi PB, Jumbam DT, Kanmounye US. Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events. Pan Afr Med J 2024; 47:143. [PMID: 38933430 PMCID: PMC11204985 DOI: 10.11604/pamj.2024.47.143.38399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/18/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.
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Affiliation(s)
- Berjo Dongmo Takoutsing
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Geneviève Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Bilong Mbangtang Celestin
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Desmond Tanko Jumbam
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
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Richardson S, Oke R, Mbianyor MA, Carvalho M, Yakue F, Essomba F, Mbuh GE, Chichom-Mefire A, Juillard C, Christie SA. Feasibility and acceptability of mobile phone-based triage tool to identify discharged trauma patients in need of further care in Cameroon. Trauma Surg Acute Care Open 2023; 8:e001157. [PMID: 38020864 PMCID: PMC10660438 DOI: 10.1136/tsaco-2023-001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Lack of routine follow-up for trauma patients after hospital discharge likely contributes to high rates of injury-related complications in Cameroon. Mobile phone contact may facilitate timely follow-up and reduce disability for high-risk patients. A previous single-center study showed promising feasibility of mobile health (mHealth) triage, but generalizability remains unknown. We evaluated the feasibility and acceptability of implementing a postdischarge mHealth triage tool at four hospitals in Cameroon. Methods Trauma patients from four Cameroonian hospitals were contacted at 2 weeks, 1, 3, and 6 months postdischarge. Program feasibility was assessed by calculating the proportion of successful contacts and overall cost. Odds of successful contact were compared using generalized estimating equations across patient socioeconomic status. Acceptability was assessed using a structured patient survey at 2 weeks and 6 months postdischarge. Results Of 3896 trauma patients, 59% were successfully contacted at 2 weeks postdischarge. Of these, 87% (1370/1587), 86% (1139/1330), and 90% (967/1069) were successfully reached at the 1-month, 3-month, and 6-month timepoints, respectively. The median cost per patient contact was US$3.17 (IQR 2.29-4.29). Higher socioeconomic status was independently associated with successful contact; rural poor patients were the least likely to be reached (adjusted OR 0.11; 95% CI 0.04 to 0.35). Almost all surveyed patients reported phone-based triage to be an acceptable follow-up method. Conclusion Telephone contact is a feasible and acceptable means to triage postdischarge trauma patients in Cameroon. While scaling an mHealth follow-up program has considerable potential to decrease injury morbidity in this setting, further research is needed to optimize inclusion of socioeconomically marginalized groups. Level of evidence Level III, prospective observational study.
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Affiliation(s)
- Shannon Richardson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Mbiarikai A Mbianyor
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Florentine Yakue
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Frank Essomba
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Golda E Mbuh
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Sabrinah Ariane Christie
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Christie SA, Mbianyor M, Oke R, Dissak-Delon F, Yakue F, Essomba F, Mbuh G, Yost M, Dicker R, Chichom-Mefire A, Juillard C. Mobile health follow-up screening to risk stratify patients in need of further care in a low resource setting: Results from a prospective multisite implementation study. J Trauma Acute Care Surg 2023; 95:699-705. [PMID: 37876247 PMCID: PMC10605648 DOI: 10.1097/ta.0000000000003991] [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: 01/15/2023] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Routine in-person follow-up for injured patients after hospital discharge is unfeasible in low- and middle-income countries where trauma morbidity and mortality are the highest. Mobile technology screening may facilitate early detection of complications and timely treatment. In this prospective, multisite implementation study, we cross-validate the performance of a cellphone screening tool developed to risk stratify trauma patients in need of further care after discharge in Cameroon. METHODS Between June 2019 and August 2022, research assistants contacted trauma patients by cellphone 2 weeks after discharge to administer a 14-question follow-up survey. All surveyed patients were asked to return for a physical examination. Physicians blinded to survey results categorized patients as low or moderate or high risk (HR) for poor outcomes without further care. Logistic regression tested associations between each survey question and physician examination. Predictive survey questions generated a preliminary model with high sensitivity for identifying patients in need of further care. RESULTS Of 1,712 successfully contacted patient households, 96% (1643) participated in telephone triage compared with 33% (560) who returned for physician examination. Physicians designated 39% (220) as being HR. On multiple logistic regression, 8 of 13 candidate triage questions were independently associated with HR. Positive survey response on the resultant eight question screen yielded 89.2% sensitivity for HR with a 10.8% false negative rate. Weighted for variable importance based on triage risk scores, 39% of triaged patients screened as low risk, 39% as moderate risk, and 22% as high risk for HR. Likelihood of HR was significantly greater for patients screening as high (odds ratio, 5.9) or moderate risk (odds ratio, 1.9; both p < 0.01). CONCLUSION Cellphone triage provides sensitive risk stratification of patients in need of further care after hospital discharge in Cameroon. Given low in-person return rates, limited resources should highly prioritize efforts to repatriate patients screening as high risk for poor outcomes. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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An SJ, Ngwira N, Davis D, Gallaher J, Charles A. Fall-Related Injuries in Malawi: Outcomes and Trends Over Time. World J Surg 2023; 47:1411-1418. [PMID: 36806561 DOI: 10.1007/s00268-023-06946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Fall-related injury (FRI) is a leading cause of injuries worldwide. Data on injury patterns and trends over time are lacking in resource-limited settings. METHODS We performed a retrospective analysis of FRI at Kamuzu Central Hospital in Malawi from 2009 to 2021. Outcomes were compared between patients presenting with FRI and those with other injury mechanisms. Bivariate and multivariate regressions were used to determine predictors of presentation following falls and mortality. We also analyzed time trends. RESULTS A total of 166,047 patients were included, of which 41,695 were patients presenting after falls (25.7%). Most FRI patients were between 5 and 45 (67.2%) and male (66.9%). Most falls occurred at home (67.3%) and resulted in extremity injuries (51.6%). The predicted probability of hospital presentation after falling is highest for children ≤ 5 years and adults > 60 years and decreases over time. On multivariate analysis, patients between 5 and 15 [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.63-1.77] and > 60 (AOR 1.14, 95% CI 1.07-1.22) and women (AOR 1.13, 95% CI 1.10-1.16) are more likely to present with FRI. Compared to patients with non-FRI, those with FRI were more likely to have been injured at school (AOR 2.16, 95% CI 2.01-2.32) and during sports and recreation (AOR 4.53, 95% CI 4.24-4.85). CONCLUSION FRI is the most common injury presentation after motor vehicle injury in this low-resource setting. This study provides essential information about FRI in Malawi over time. Our findings can help inform resource allocation and injury prevention initiatives.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA
| | - Natasha Ngwira
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi
| | - Dylane Davis
- School of Medicine, University of North Carolina at Chapel Hill, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC, 27599, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA.
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi.
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Pickering AE, Malherbe P, Nambuba J, Bills CB, Hynes EC, Rice B. Clinical emergency care quality indicators in Africa: a scoping review and data summary. BMJ Open 2023; 13:e069494. [PMID: 37130667 PMCID: PMC10163454 DOI: 10.1136/bmjopen-2022-069494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Emergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators. DESIGN We conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature. DATA SOURCES PubMed (1964-2 January 2022), Embase (1947-2 January 2022) and CINAHL (1982-3 January 2022) and various forms of grey literature were queried. ELIGIBILITY CRITERIA Studies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as 'AFEM-CC quality indicators near match'. DATA EXTRACTION AND SYNTHESIS Document screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated. RESULTS One thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 'AFEM-CC quality indicators near match' publications were identified (38 new publications and 15 previously identified studies that contained additional 'near match' data), yielding 87 data points. CONCLUSIONS Data relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
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Affiliation(s)
- Ashley E Pickering
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Petrus Malherbe
- Emergency Medicine, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Joan Nambuba
- Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Corey B Bills
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie Calvello Hynes
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Brian Rice
- Emergency Medicine, Stanford University, Palo Alto, California, USA
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Christie SA, Zheng D, Dissak-Delon F, Kinge T, Njock R, Nkusu D, Tsiagadigui JG, Mbianyor M, Dicker R, Chichom-Mefire A, Juillard C. How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement. J Trauma Acute Care Surg 2023; 94:288-294. [PMID: 36163642 PMCID: PMC9877108 DOI: 10.1097/ta.0000000000003768] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Injury deaths in sub-Saharan Africa are among the world's highest, but hospital data rarely have sufficient granularity to direct quality improvement. We analyzed clinical care patterns among trauma patients who died in a prospective, multicenter sub-Saharan cohort to pinpoint trauma quality improvement intervention targets. METHODS In-hospital trauma deaths in four Cameroonian hospitals between 2017 and 2019 were included. Trauma registry data on patient demographics, injury characteristics, and clinical care were analyzed to identify opportunities for systems improvements. RESULTS Among 9,423 trauma patients, there were 236 deaths. Overall, 83% of patients who died in the emergency department were living on arrival (LOA). Among 183 LOA patients, 30% presented with normal vital signs, but 11% had no vital signs taken, often because of lack of equipment (43%). Of LOA patients presenting with a Glasgow Coma Scale score of <9 (56%), few received neurosurgery consults (15%), C-collar placement (9%), or intubation (1%). The most common reason for lack of c-collar placement was failure to recognize that it was indicated (66%). Tracheal deviation, unequal breath sounds, or paradoxical chest movement were present in 63% of LOA patients, but only two patients had chest tubes placed. Hypotension or active bleeding was present in 80% of LOA patients; while crystalloid bolus was given to 96% of these patients, few received transfusion (8%), tourniquet placement for extremity injury (6%), or an operation (4%). CONCLUSION Primary survey interventions are underperformed in trauma nonsurvivors in Cameroon. Protocolizing early treatment for head injury, hemorrhagic shock, and chest wall trauma could reduce trauma mortality. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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Affiliation(s)
| | - Dennis Zheng
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, California, USA
| | - Fanny Dissak-Delon
- Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
| | - Thompson Kinge
- Hospital Administration, The Limbe Regional Hospital; Limbe, Cameroon
| | - Richard Njock
- Hospital Administration, The Laquintinie Hospital of Douala; Douala, Cameroon
| | - Daniel Nkusu
- Hospital Administration, The Catholic Hospital of Pouma; Pouma Cameroon
| | | | - Mbiarikai Mbianyor
- Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
| | - Rochelle Dicker
- Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
| | | | - Catherine Juillard
- Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
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Establishing Pediatric Trauma Programs in Low- and Middle-Income Countries. CURRENT TRAUMA REPORTS 2023. [DOI: 10.1007/s40719-023-00252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yost MT, Carvalho MM, Mbuh L, Dissak-Delon FN, Oke R, Guidam D, Nlong RM, Zikirou MM, Mekolo D, Banaken LH, Juillard C, Chichom-Mefire A, Christie SA. Back to the basics: Clinical assessment yields robust mortality prediction and increased feasibility in low resource settings. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001761. [PMID: 36989211 PMCID: PMC10057736 DOI: 10.1371/journal.pgph.0001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Mortality prediction aids clinical decision-making and is necessary for trauma quality improvement initiatives. Conventional injury severity scores are often not feasible in low-resource settings. We hypothesize that clinician assessment will be more feasible and have comparable discrimination of mortality compared to conventional scores in low and middle-income countries (LMICs). METHODS Between 2017 and 2019, injury data were collected from all injured patients as part of a prospective, four-hospital trauma registry in Cameroon. Clinicians used physical exam at presentation to assign a highest estimated abbreviated injury scale (HEAIS) for each patient. Discrimination of hospital mortality was evaluated using receiver operating characteristic curves. Discrimination of HEAIS was compared with conventional scores. Data missingness for each score was reported. RESULTS Of 9,635 presenting with injuries, there were 206 in-hospital deaths (2.2%). Compared to 97.5% of patients with HEAIS scores, only 33.2% had sufficient data to calculate a Revised Trauma Score (RTS) and 24.8% had data to calculate a Kampala Trauma Score (KTS). Data from 2,328 patients with all scores was used to compare models. Although statistically inferior to the prediction generated by RTS (AUC 0.92-0.98) and KTS (AUC 0.93-0.99), HEAIS provided excellent overall discrimination of mortality (AUC 0.84-0.92). Among 9,269 patients with HEAIS scores was strongly predictive of mortality (AUC 0.93-0.96). CONCLUSION Clinical assessment of injury severity using HEAIS strongly predicts hospital mortality and far exceeds conventional scores in feasibility. In contexts where traditional scoring systems are not feasible, utilization of HEAIS could facilitate improved data quality and expand access to quality improvement programming.
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Affiliation(s)
- Mark T Yost
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America
| | - Melissa M Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lidwine Mbuh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America
| | - Debora Guidam
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Rene M Nlong
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - David Mekolo
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Louis H Banaken
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America
| | | | - S Ariane Christie
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America
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Keating EM, Sakita F, Mmbaga BT, Nkini G, Amiri I, Tsosie C, Fino N, Watt MH, Staton CA. A cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania. Afr J Emerg Med 2022; 12:208-215. [PMID: 35719184 PMCID: PMC9188958 DOI: 10.1016/j.afjem.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Pediatric injuries in low- and middle-income countries are a leading cause of morbidity and mortality worldwide. Implementing hospital-based trauma registries can reduce the knowledge gap in both hospital care and patient outcomes and lead to quality improvement initiatives. The goal of this study was to create a pediatric trauma registry to provide insight into the epidemiology, outcomes, and factors associated with poor outcomes in injured children. Methods This was a prospective observational study in which a pediatric trauma registry was implemented at a large zonal referral hospital in Northern Tanzania. Data included demographics, hospital-based care, and outcomes including morbidity and mortality. Data were input into REDCap© and analyzed using ANOVA and Chi-squared tests in SAS(Version 9.4)©. Results 365 patients were enrolled in the registry from November 2020 to October 2021. The majority were males (n=240, 65.8%). Most were children 0-5 years (41.7%, n=152), 34.5% (n=126) were 6-11 years, and 23.8% (n=87) were 12-17 years. The leading causes of pediatric injuries were falls (n=137, 37.5%) and road traffic injuries (n=125, 34.5%). The mortality rate was 8.2% (n=30). Of the in-hospital deaths, 43.3% were children with burn injuries who also had a higher odds of mortality than children with other injuries (OR 8.72, p<0.001). The factors associated with in-hospital mortality and morbidity were vital sign abnormalities, burn severity, abnormal Glasgow Coma Score, and ICU admission. Conclusion The mortality rate of injured children in our cohort was high, especially in children with burn injuries. In order to reduce morbidity and mortality, interventions should be prioritized that focus on pediatric injured patients that present with abnormal vital signs, altered mental status, and severe burns. These findings highlight the need for health system capacity building to improve outcomes of pediatric injury patients in Northern Tanzania.
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Affiliation(s)
- Elizabeth M. Keating
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Chermiqua Tsosie
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Nora Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Melissa H. Watt
- Department of Population Health Sciences, Salt Lake City, University of Utah, UT, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, NC, USA
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Blair KJ, Dissak-Delon FN, Oke R, Carvalho M, Hubbard A, Mbianyor M, Etoundi-Mballa GA, Kinge T, Njock LR, Nkusu DN, Tsiagadigui JG, Dicker RA, Chichom-Mefire A, Juillard C, Christie SA. Chronic Disease Comorbidities Among Injured Patients in Cameroon: A Retrospective Cohort Study. J Surg Res 2022; 280:74-84. [PMID: 35964485 DOI: 10.1016/j.jss.2022.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/20/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Chronic diseases are increasing but underdiagnosed in low-income and middle-income countries (LMICs), where injury mortality is already disproportionately high. We estimated prevalence of known chronic disease comorbidities and their association with outcomes among injured patients in Cameroon. MATERIALS AND METHODS Injured patients aged ≥15 y presenting to four Cameroonian hospitals between October 2017 and January 2020 were included. Our explanatory variable was known chronic disease; prevalence was age-standardized. Outcomes were overall in-hospital mortality and admission or transfer from the emergency department (ED). Associations between known chronic disease and outcomes were evaluated using logistic regression adjusted for age, gender, estimated injury severity score (eISS), hospital, and household socioeconomic status. Unadjusted eISS-stratified and age-stratified outcomes were also compared via chi-squared tests. RESULTS Of 7509 injured patients, 370 (4.9%) reported at least one known chronic disease; age-standardized prevalence was 8.4% (95% confidence interval [CI] 7.5%-9.2%). Patients with known chronic disease had higher mortality (4.6% versus 1.5%, adjusted odds ratio [aOR]: 2.61 [95% CI: 1.25-5.47], P = 0.011) and were more likely to be admitted or transferred from the ED (38.7% versus 19.8%, aOR: 1.40 [95% CI: 1.02-1.92], P = 0.038) compared to those without known comorbidities. Crude differences in mortality (11.3% versus 3.3%, P = 0.002) and hospital admission or transfer (63.8% versus 46.6%, P = 0.011) were most notable for patients with eISS 16-24. CONCLUSIONS Despite underdiagnosis among Cameroonians, we demonstrated worse injury outcomes among those with known chronic diseases. Integrating chronic disease screening with injury care may help address underdiagnosis in Cameroon. Future work should assess whether chronic disease prevention in LMICs could improve injury outcomes.
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Affiliation(s)
- Kevin J Blair
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California.
| | - Fanny N Dissak-Delon
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California
| | - Mbiarikai Mbianyor
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | | | - Thompson Kinge
- Hospital Administration, The Limbe Regional Hospital, Limbe, Cameroon
| | - Louis Richard Njock
- Hospital Administration, The Laquintinie Hospital of Douala, Douala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, The Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Alain Chichom-Mefire
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - S Ariane Christie
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California; Division of General and Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania
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11
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Chokotho L, Croke K, Mohammed M, Mulwafu W, Bertfelt J, Karpe S, Milusheva S. Epidemiology of adult trauma injuries in Malawi: results from a multisite trauma registry. Inj Epidemiol 2022; 9:14. [PMID: 35440067 PMCID: PMC9017418 DOI: 10.1186/s40621-022-00379-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background Large-scale multisite trauma registries with broad geographic coverage in low-income countries are rare. This lack of systematic trauma data impedes effective policy responses. Methods All patients presenting with trauma at 10 hospitals in Malawi from September 2018 to March 2020 were enrolled in a prospective registry. Using data from 49,241 cases, we analyze prevalence, causes, and distribution of trauma in adult patients, and timeliness of transport to health facilities and treatment. Results Falls were the most common mechanism of injury overall, but road traffic crashes (RTCs) were the most common mechanism of serious injury, accounting for (48%) of trauma admissions. This pattern was consistent across all central and district hospitals, with only one hospital recording < 40% of admissions due to RTCs. 49% of RTC-linked trauma patients were not in motorized vehicles at the time of the crash. 84% of passengers in cars/trucks/buses and 48% of drivers of cars/trucks/buses from RTCs did not wear seatbelts, and 52% of motorcycle riders (driver and passenger) did not wear helmets. For all serious trauma cases (defined as requiring hospital admission), median time to hospital arrival was 5 h 20 min (IQR 1 h 20 min, 24 h). For serious trauma cases that presented on the same day that trauma occurred, median time to hospital arrival was 2 h (IQR 1 h, 11 h). Significant predictors of hospital admission include being involved in an RTC, age > 55, Glasgow Coma Score < 12, and presentation at hospital on a weekend. Conclusions RTCs make up almost half of hospitalized trauma cases in this setting, are equally common in referral and district hospitals, and are an important predictor of injury severity. Pedestrians and cyclists are just as affected as those in vehicles. Many of those injured in vehicles do not take adequate safety precautions. Most trauma patients, including those with serious injuries, do not receive prompt medical attention. Greater attention to safety for both motorized and especially non-motorized road users, and more timely, higher quality emergency medical services, are important policy priorities for Malawi and other developing countries with high burdens of RTC trauma. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00379-5.
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Affiliation(s)
- Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi, Mahatma Gandhi, Blantyre, Malawi
| | - Kevin Croke
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA.
| | - Meyhar Mohammed
- Development Impact Evaluation, World Bank, 1818 H St NW, Washington, DC, 20433, USA
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Mahatma Gandhi, Blantyre, Malawi
| | - Jonna Bertfelt
- Development Impact Evaluation, World Bank, 1818 H St NW, Washington, DC, 20433, USA
| | - Saahil Karpe
- Development Impact Evaluation, World Bank, 1818 H St NW, Washington, DC, 20433, USA
| | - Sveta Milusheva
- Development Impact Evaluation, World Bank, 1818 H St NW, Washington, DC, 20433, USA
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12
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Asadi F, Hosseini MA, Almasi S. Reliability of trauma coding with ICD-10. Chin J Traumatol 2022; 25:102-106. [PMID: 34419337 PMCID: PMC9039840 DOI: 10.1016/j.cjtee.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/28/2021] [Accepted: 06/29/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The reliability of trauma coding is essential in establishing the reliable trauma data and adopting efficient control and monitoring policies. The present study aimed to determine the reliability of trauma coding in educational hospitals affiliated to Shahid Beheshti University of Medical Sciences, Iran. METHODS In this descriptive cross-sectional study, 591 coded medical records with a trauma diagnosis in 2018 were selected and recoded by two coders. The reliability of trauma coding was calculated using Cohen's kappa. The data were recorded in a checklist, in which the validity of the content had been confirmed by experts. RESULTS The reliability of the coding related to the nature of trauma in research units was 0.75-0.77, indicating moderate reliability. Also, the reliability of the coding of external causes of trauma was 0.57-0.58, suggesting poor reliability. CONCLUSION The reliability of trauma coding both in terms of the nature of trauma and the external causes of trauma does not have a good status in the research units. This can be due to the complex coding of trauma, poor documentation of the cases, and not studying the entire case. Therefore, holding training courses for coders, offering training on the accurate documentation to other service providers, and periodically auditing the medical coding are recommended.
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13
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Blair KJ, de Virgilio M, Dissak-Delon FN, Dang LE, Christie SA, Carvalho M, Oke R, Mbianyor MA, Hubbard AE, Etoundi AM, Kinge T, Njock RL, Nkusu DN, Tsiagadigui JG, Dicker RA, Chichom-Mefire A, Juillard C. Associations between social determinants of health and interpersonal violence-related injury in Cameroon: a cross-sectional study. BMJ Glob Health 2022; 7:bmjgh-2021-007220. [PMID: 35022181 PMCID: PMC8756282 DOI: 10.1136/bmjgh-2021-007220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Risk factors for interpersonal violence-related injury (IPVRI) in low-income and middle-income countries (LMICs) remain poorly defined. We describe associations between IPVRI and select social determinants of health (SDH) in Cameroon. Methods We conducted a cross-sectional analysis of prospective trauma registry data collected from injured patients >15 years old between October 2017 and January 2020 at four Cameroonian hospitals. Our primary outcome was IPVRI, compared with unintentional injury. Explanatory SDH variables included education level, employment status, household socioeconomic status (SES) and alcohol use. The EconomicClusters model grouped patients into household SES clusters: rural, urban poor, urban middle-class (MC) homeowners, urban MC tenants and urban wealthy. Results were stratified by sex. Categorical variables were compared via Pearson’s χ2 statistic. Associations with IPVRI were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results Among 7605 patients, 5488 (72.2%) were men. Unemployment was associated with increased odds of IPVRI for men (aOR 2.44 (95% CI 1.95 to 3.06), p<0.001) and women (aOR 2.53 (95% CI 1.35 to 4.72), p=0.004), as was alcohol use (men: aOR 2.33 (95% CI 1.91 to 2.83), p<0.001; women: aOR 3.71 (95% CI 2.41 to 5.72), p<0.001). Male patients from rural (aOR 1.45 (95% CI 1.04 to 2.03), p=0.028) or urban poor (aOR 2.08 (95% CI 1.27 to 3.41), p=0.004) compared with urban wealthy households had increased odds of IPVRI, as did female patients with primary-level/no formal (aOR 1.78 (95% CI 1.10 to 2.87), p=0.019) or secondary-level (aOR 1.54 (95% CI 1.03 to 2.32), p=0.037) compared with tertiary-level education. Conclusion Lower educational attainment, unemployment, lower household SES and alcohol use are risk factors for IPVRI in Cameroon. Future research should explore LMIC-appropriate interventions to address SDH risk factors for IPVRI.
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Affiliation(s)
- Kevin J Blair
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Michael de Virgilio
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Lauren Eyler Dang
- Division of Biostatistics, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - S Ariane Christie
- Department of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Mbiarikai Agbor Mbianyor
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alan E Hubbard
- Division of Biostatistics, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Alain Mballa Etoundi
- Department of Disease Epidemic and Pandemic Control, Cameroon Ministry of Public Health, Yaoundé, Cameroon
| | - Thompson Kinge
- Hospital Administration, Limbe Regional Hospital, Limbe, Southwest Region, Cameroon
| | - Richard L Njock
- Hospital Administration, Hopital Laquintinie de Duoala, Duoala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alain Chichom-Mefire
- Department of Surgery and Obs/Gyn, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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14
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Embolo FN, Bellamkonda N, Dickson D, Motwani G, Mbeboh SN, Mbiarikai M, Oben E, Oke R, Dicker RA, Juillard C, Christie SA, Chichom-Mefire A. Epidemiology of traumatic brain injury based on clinical symptoms amongst inhabitants of the Southwest Region of Cameroon: a community-based study. Brain Inj 2021; 35:1184-1191. [PMID: 34383629 DOI: 10.1080/02699052.2021.1957150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The majority of studies investigating the epidemiology of traumatic brain injury (TBI) in sub-Saharan Africa are primarily hospital-based, missing fatal, mild, and other cases of TBI that do not present to formal care settings. This study aims to bridge this gap in data by describing the epidemiology of TBI in the Southwest Region of Cameroon. METHODS This was a cross-sectional community-based study. Using a three-stage cluster sampling, local research assistants surveyed households with a pre-tested questionnaire to identify individuals with symptoms of TBI in nine health districts in the Southwest Region of Cameroon from 2016 to 2017. RESULTS Data gathered on 8,065 individuals revealed 78 cases of suspected TBI. Road traffic injury (RTI) comprised 55% of subjects' mechanism of injury. Formal medical care was sought by 82.1% of subjects; three subjects died at the time of injury. Following injury, 59% of subjects reported difficulty affording basic necessities and 87.2% of subjects were unable to perform activities of their primary occupation. CONCLUSIONS This study postulates an incidence of TBI in Southwest Cameroon of 975.57 per 100,000 individuals, significantly greater than prior findings. A large proportion of TBI is secondary to RTI.
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Affiliation(s)
- Frida N Embolo
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Nikhil Bellamkonda
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Drusia Dickson
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Girish Motwani
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Susan N Mbeboh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Mbianyor Mbiarikai
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Eunice Oben
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - S Ariane Christie
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
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15
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Ciccone EJ, Tilly AE, Chiume M, Mgusha Y, Eckerle M, Namuku H, Crouse HL, Mkaliainga TB, Robison JA, Schubert CJ, Mvalo T, Fitzgerald E. Lessons learned from the development and implementation of an electronic paediatric emergency and acute care database in Lilongwe, Malawi. BMJ Glob Health 2021; 5:bmjgh-2020-002410. [PMID: 32675067 PMCID: PMC7368472 DOI: 10.1136/bmjgh-2020-002410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022] Open
Abstract
As the field of global child health increasingly focuses on inpatient and emergency care, there is broad recognition of the need for comprehensive, accurate data to guide decision-making at both patient and system levels. Limited financial and human resources present barriers to reliable and detailed clinical documentation at hospitals in low-and-middle-income countries (LMICs). Kamuzu Central Hospital (KCH) is a tertiary referral hospital in Malawi where the paediatric ward admits up to 3000 children per month. To improve availability of robust inpatient data, we collaboratively designed an acute care database on behalf of PACHIMAKE, a consortium of Malawi and US-based institutions formed to improve paediatric care at KCH. We assessed the existing health information systems at KCH, reviewed quality care metrics, engaged clinical providers and interviewed local stakeholders who would directly use the database or be involved in its collection. Based on the information gathered, we developed electronic forms collecting data at admission, follow-up and discharge for children admitted to the KCH paediatric wards. The forms record demographic information, basic medical history, clinical condition and pre-referral management; track diagnostic processes, including laboratory studies, imaging modalities and consults; and document the final diagnoses and disposition obtained from clinical files and corroborated through review of existing admission and death registries. Our experience with the creation of this database underscores the importance of fully assessing existing health information systems and involving all stakeholders early in the planning process to ensure meaningful and sustainable implementation.
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Affiliation(s)
- Emily J Ciccone
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alyssa E Tilly
- Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yamikani Mgusha
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Howard Namuku
- Department of Information Communication Technology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Heather L Crouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jeff A Robison
- Division of Pediatric Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Charles J Schubert
- Departments of Pediatrics and Family/Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tisungane Mvalo
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Fitzgerald
- Division of Emergency Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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16
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Nottidge TE, Nottidge BA, Udomesiet IC, Uduehe EE. Developing a Low-resource Approach to Trauma Patient Care - Findings from a Nigerian Trauma Registry. Niger J Surg 2021; 27:9-15. [PMID: 34012235 PMCID: PMC8112371 DOI: 10.4103/njs.njs_67_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/06/2020] [Accepted: 07/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries. Objective: This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective. Methods: Trauma registry data from January 2013 to June 2014 were analyzed. Results: A total of 542 patients were included in the study. The mean age of the patients was 33.43 ± 12.79 years; the median time from injury to arrival at the hospital was 3 h (interquartile range IQR 1 – 5.1 h); three-quarters of the patients sustained their injuries on the road-tricycles were rarely involved in road traffic injuries (RTIs) (6.9% of RTIs) but were used in transporting a third of the patients whose data on means of transportation were captured. There were 15 (2.7%) deaths in the first 24 h period postinjury covered by the study – 13 (86.7%) of these patients had head-and-neck injury. About half of the assault injury (50.5%) was from persons known to the victim. The shock indices suggested that a majority of the patients were not at a high risk of mortality. Conclusion: Most of the trauma patients at our hospital were in low- to middle-income categories. The median time to arrival of injured patients was 3 h (IQR 1 – 6 h). Most injuries occurred on the road because of RTIs. The involvement of tricycles in accidents was uncommon, but they were used fairly commonly by lay responders in transporting the injured victim to hospital. A high proportion of assailants were known to the victim. The use of trauma registries provides essential data for prioritizing limited resources and can guide a contextualized approach to reducing trauma and improving trauma patient care.
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Affiliation(s)
- Timothy E Nottidge
- Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
| | - Bolanle A Nottidge
- Department of Physiotherapy, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
| | - Ifiok C Udomesiet
- Department of Orthopaedics and Traumatology, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria.,Department of Accident and Emergency, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
| | - Enoette E Uduehe
- Department of Surgery, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
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17
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Drevin G, Albutt K, Baluku M, Tuhumwiire C, Deng H, Musinguzi N, Modest V, Ngonzi J, Ttendo S, Firth P. Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database. World J Surg 2021; 44:2550-2556. [PMID: 32333160 DOI: 10.1007/s00268-020-05537-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Five billion people lack access to surgery. Accurate and complete data have been identified as essential to the global scale-up of perioperative care. This study retrospectively validates the Mbarara Surgical Services Quality Assurance Database (SQUAD), an electronic outcomes database at a Ugandan secondary referral hospital. METHODS SQUAD data were compared to paper records from August 2013 to January 2017. To assess data entry accuracy, two researchers independently extracted 24 patient variables from 170 charts. To assess completeness of patient capture, SQUAD entries were compared to a sample of charts returned to the Medical Records Department, and to a sample of entries in ward and operating room logbooks. Two-tailed binomial proportions with 95% CI were calculated from the comparative results of patient observations, against a predefined accuracy of 0.85-0.95. RESULTS Agreement between completed validation observations from charts and SQUAD data was 91.5% (n = 3734/4080 data points). Binomial tests indicated that 15 variables had higher than 95% accuracy. A total 19 of 24 variables had ≥ 85% accuracy. The completeness of SQUAD patient capture was 98.2% (n = 167/170) of charts returned to the Medical Records Department, 97.5% (n = 198/203) of operating logbook entries, and 100% (n = 111/111) of ward logbook entries, respectively. CONCLUSION SQUAD closely reflects the primary surgical and anaesthetic data at a Ugandan secondary hospital. Data accuracy of key variables and completeness of population capture were comparable to those of databases in high-income countries and outperformed those of other low- and middle-income countries.
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Affiliation(s)
- Gustaf Drevin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Moris Baluku
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caleb Tuhumwiire
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Nicholas Musinguzi
- Harvard-Mbarara University of Science and Technology Collaborative, Mbarara, Uganda
| | - Vicki Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul Firth
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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18
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Mohammed Z, Arafa A, Senosy S, El-Morsy EMA, El-Bana E, Saleh Y, Hirshon JM. Completeness of Medical Records of Trauma Patients Admitted to the Emergency Unit of a University Hospital, Upper Egypt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E83. [PMID: 33374262 PMCID: PMC7795587 DOI: 10.3390/ijerph18010083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Trauma records in Egyptian hospitals are widely suspected to be inadequate for developing a practical and useful trauma registry, which is critical for informing both primary and secondary prevention. We reviewed archived paper records of trauma patients admitted to the Beni-Suef University Hospital in Upper Egypt for completeness in four domains: demographic data including contact information, administrative data tracking patients from admission to discharge, clinical data including vital signs and Glasgow Coma Scale scores, and data describing the causal traumatic event (mechanism of injury, activity at the time of injury, and location/setting). The majority of the 539 medical records included in the study had significant deficiencies in the four reviewed domains. Overall, 74.3% of demographic fields, 66.5% of administrative fields, 55.0% of clinical fields, and just 19.9% of fields detailing the causal event were found to be completed. Critically, oxygen saturation, arrival time, and contact information were reported in only 7.6%, 25.8%, and 43.6% of the records, respectively. Less than a fourth of the records provided any details about the cause of trauma. Accordingly, the current, paper-based medical record system at Beni-Suef University Hospital is insufficient for the development of a practical trauma registry. More efforts are needed to develop efficient and comprehensive documentation of trauma data in order to inform and improve patient care.
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Affiliation(s)
- Zeinab Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Ahmed Arafa
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Shaimaa Senosy
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
| | - El-Morsy Ahmed El-Morsy
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
| | - Emad El-Bana
- Department of Orthopedic Surgery, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt;
| | - Yaseen Saleh
- College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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19
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Croke K, Chokotho L, Milusheva S, Bertfelt J, Karpe S, Mohammed M, Mulwafu W. Implementation of a multi-center digital trauma registry: Experience in district and central hospitals in Malawi. Int J Health Plann Manage 2020; 35:1157-1172. [PMID: 32715521 DOI: 10.1002/hpm.3023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Trauma is a rapidly growing component of the burden of disease in developing countries; yet systematic data collection about trauma in such contexts is relatively rare. METHODS This paper describes the implementation of a trauma registry in 10 government-run hospitals in Malawi, with a focus on implementation logistics, stakeholder engagement strategies, and data quality procedures. RESULTS 51 337 trauma cases were recorded over the first 14 months of registry operations. The number of cases per month, data accuracy, and the geographic coverage of the registry improved over time as data quality measures were implemented. CONCLUSIONS Multi-center digital trauma registries are feasible in low-resource settings. Stakeholder engagement, periodic in-person and frequent digital follow up with data teams, and regular channeling of findings back to data collection teams help to improve data quality and completeness over a 14 month period. Financial and staffing constraints remain challenges for sustainability over time, but this experience demonstrates the feasibility of large-scale registry operations.
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Affiliation(s)
- Kevin Croke
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi, Zomba, Malawi
| | - Sveta Milusheva
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Jonna Bertfelt
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Saahil Karpe
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Meyhar Mohammed
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Wakisa Mulwafu
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
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Takoukam R, Kanmounye US, Robertson FC, Zimmerman K, Nguembu S, Lartigue JW, Park KB, Figuim B, Esene I. Prehospital Conditions and Outcomes After Craniotomy for Traumatic Brain Injury Performed Within 72 Hours in Central Cameroon: A Cross-Sectional Study. World Neurosurg 2020; 142:e238-e244. [PMID: 32599210 DOI: 10.1016/j.wneu.2020.06.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the most common neurosurgical condition globally. In Cameroon, there are 572 cases of TBI per 100,000 people, but <40% of Cameroonians live within 4 hours of a neurosurgical facility. We sought to understand the clinical outcomes at a neurosurgical center in Central Cameroon. METHODS This cross-sectional study was conducted at the largest neurosurgical center of Cameroon, the Yaounde Central Hospital. Data included 100 consecutive patients undergoing an intervention 72 hours after their injury from February 1, 2015 to February 1, 2019. Patients with missing data or undergoing surgery >72 hours after injury were excluded. Analyses of covariance were performed, and a P value >0.05 was considered significant. A Kaplan-Meier survival curve was computed. RESULTS The patients had a mean age of 31.3 ± 17.4 years, with a male predominance of 91.0%, and the principal mechanism of injury was road traffic accidents (68.0%). Only 11% arrived via ambulance, and 36.0% were admitted <3 hours after the traumatic event. The postoperative mortality was 15.0%, mean survival was 25.0 postoperative days (95% confidence interval, 23.42-26.52), and the mean Glasgow Outcome Scale score at 28 days was 3.9 ± 1.4. CONCLUSIONS Most patients with TBI undergoing neurosurgery 72 hours after injury in Cameroon arrive at the hospital late and have a high mortality risk during the first postoperative week. Investments in prehospital care should be made to improve surgical outcomes.
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Affiliation(s)
- Régis Takoukam
- Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon; Department of Neurosurgery, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ulrick Sidney Kanmounye
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon; Global Neurosurgery Initiative, Program in Global Neurosurgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathrin Zimmerman
- Global Neurosurgery Initiative, Program in Global Neurosurgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; School of Medicine, University of Alabama at Birminghssam, Birmingham, Alabama, USA
| | - Stéphane Nguembu
- Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon; Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Jean W Lartigue
- Global Neurosurgery Initiative, Program in Global Neurosurgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Neurosurgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Bello Figuim
- Department of Neurosurgery, Yaounde Central Hospital, Yaounde, Cameroon
| | - Ignatius Esene
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon; Department of Neurosurgery, Garoua Regional Hospital, Garoua, Cameroon
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21
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Laytin AD, Seyoum N, Kassa S, Juillard CJ, Dicker RA. Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening. Afr J Emerg Med 2020; 10:58-63. [PMID: 32612909 PMCID: PMC7320203 DOI: 10.1016/j.afjem.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/31/2022] Open
Abstract
Background Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening.
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Rosenkrantz L, Schuurman N, Arenas C, Nicol A, Hameed MS. Maximizing the potential of trauma registries in low-income and middle-income countries. Trauma Surg Acute Care Open 2020; 5:e000469. [PMID: 32426528 PMCID: PMC7228665 DOI: 10.1136/tsaco-2020-000469] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 11/03/2022] Open
Abstract
Injury is a major global health issue, resulting in millions of deaths every year. For decades, trauma registries have been used in wealthier countries for injury surveillance and clinical governance, but their adoption has lagged in low-income and middle-income countries (LMICs). Paradoxically, LMICs face a disproportionately high burden of injury with few resources available to address this pandemic. Despite these resource constraints, several hospitals and regions in LMICs have managed to develop trauma registries to collect information related to the injury event, process of care, and outcome of the injured patient. While the implementation of these trauma registries is a positive step forward in addressing the injury burden in LMICs, numerous challenges still stand in the way of maximizing the potential of trauma registries to inform injury prevention, mitigation, and improve quality of trauma care. This paper outlines several of these challenges and identifies potential solutions that can be adopted to improve the functionality of trauma registries in resource-poor contexts. Increased recognition and support for trauma registry development and improvement in LMICs is critical to reducing the burden of injury in these settings.
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Affiliation(s)
- Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Claudia Arenas
- Division of Trauma Surgery, Hospital Sotero del Rio, Santiago, Chile.,Division of General Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Andrew Nicol
- Department of Surgery, University of Cape Town, Observatory, Western Cape, South Africa.,Trauma Centre, Groote Schuur Hospital, Observatory, Western Cape, South Africa
| | - Morad S Hameed
- Division of General Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Sawe HR, Reynolds TA, Weber EJ, Mfinanga JA, Coats TJ, Wallis LA. Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry. BMC Emerg Med 2020; 20:29. [PMID: 32326896 PMCID: PMC7178583 DOI: 10.1186/s12873-020-00325-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background In Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set. Methods This was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables. Results During the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts. Conclusions In the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.
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Affiliation(s)
- Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa.
| | - Teri A Reynolds
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa.,Department for the Management of NCDs, Disability, Violence and Injury Prevention, Integrated Health Services, World Health Organization (WHO), 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ellen J Weber
- Emergency Department, University of California San-Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Juma A Mfinanga
- Department of Emergency Medicine, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Timothy J Coats
- Department of Cardiovascular Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Lee A Wallis
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa
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Bedry T, Tadele H. Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study. Emerg Med Int 2020; 2020:1965231. [PMID: 32399303 PMCID: PMC7204112 DOI: 10.1155/2020/1965231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is the most common cause of death/disability in children. The Glasgow coma scale and other parameters are used for treatment/follow-up of TBI. Childhood TBI data are scarce from sub-Saharan Africa. The study aimed to determine the pattern and predictors of the TBI outcome in Southern Ethiopia. METHODS An observational cross-sectional study was conducted from September 2017 to September 2018 at Hawassa University Hospital. Structured questionnaires were used for data collection. Significant associations were declared at a P value of <0.05. RESULTS There were 4,258 emergency room (ER) visits during the study period, and TBI contributed to 317 (7.4%) cases. The mean age of study subjects was 7.66 ± 3.88 years. Boys, predominantly above 5 years of age, comprise 218 (68.8%) of the study subjects with a male to female ratio of 2.2 : 1. Pedestrian road traffic accidents (RTA), 120 (37.9%), and falls, 104 (32.8%), were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231 (72.9%), 61 (19.2%), and 25 (7.9%) of cases, respectively. Most of the TBI cases presented within 24 hrs of injury, 258 (81.4%). Recovery with no neurologic deficit, 267 (84.2%); focal neurologic deficit, 30 (9.5%); depressed mentation, 10 (3.2%); and death, 10 (3.2%), were documented. Signs of increased intracranial pressure (ICP) at admission [AOR: 1.415 (95% CI: 1.4058-9.557)], severe TBI [AOR: 2.553 (95% CI: 1.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 1.873-7.874)], and presence of contusion, diffuse axonal injury (DAI), or intracranial bleeding on the head computed tomography (CT) scan [AOR: 2.45 (95% CI: 1.811-7.952)] predicted poor TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Pedestrian RTA and falls, early presentation (<24 hours of injury), and mild form of TBI among boys were the most common documented patterns. ICP, hyperglycemia, severe TBI, and presence of contusion, DAI, or intracranial bleeding on head CT predicted poor outcome. Strategies to ensure road safety and to prevent falls and animal-related injuries and TBI follow-up for ICP and glycemic controls are recommended.
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Affiliation(s)
- Tuji Bedry
- Department of Pediatrics and Child Health, College of Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Henok Tadele
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gebru AA, Mosadeghrad AM, Sari AA, Tafesse TB, Kahsay WG. Prevalence, pattern, magnitude and associated factors of trauma in the Emergency Department at Health Institutes in Ethiopia: A systematic review. Hum Antibodies 2019; 27:1-10. [PMID: 30909202 DOI: 10.3233/hab-190363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is one of the important public health problems that causes significant economic and social crisis with more than 10% of all disease cases are associated with it. We aimed to identify and describe the prevalence, patterns, magnitude and associated factors of trauma in the Emergency Department at Health Institute in Ethiopia. METHODS In this systematic review, we searched for peer-reviewed and grey literature publications reporting the prevalence, pattern, magnitude and associated factors of trauma between 2000 and 2019. The documents which recruited are directly related to trauma and emergency department. In this regard, we searched databases of PubMed, Elsevier, Science directed, MEDLINE, and Google scholar by using Google as searching engine. Furthermore, publication with secondary data and not in English was excluded. FINDINGS A total of 9,768 injured participants were included in the studies, of which 71.2% (6950) were males. Among the injured participants, 53.4% of cases were living in Addis Ababa followed by Gondar and Jimma with 20.3% and 11.3% cases, respectively. Severe road traffic accident, occupational injury, and surgical patients were among the major risk factors of trauma. The mortality rate of the trauma case fatality was reached about 4%. The majority of the studies (37.5%) analyzed the pattern and magnitude of trauma among patients seen at emergency outpatient department of health institutes in Ethiopia. The largest percentage of studies (62.5%) relied on systematic random sampling. Thirty eight percent of the reviewed studies were utilized retrospective approaches to address the research questions. An completed the registry forms and/or Kampla Trauma Score (KTS), which accounted for 37.5% of articles on prevalence, pattern, magnitude and associated factors of trauma in the emergency was the most commonly used strategy. The majority (75%) of the reviewed studies were used both descriptive statistics and bivarate and multivariate logistic regression for data analysis. The majority 6950 (71%) of the participants who have been included in those reviewed articles were male and 2818 (29%) were female by gender. Meanwhile, the majority 5 (62.5%) of reviewed studies had included < 1000 injured persons. CONCLUSION The degree and types of injuries in different hospitals in Ethiopia was considerably high and its casualty is also under predictable. Therefore, a variety of actions including policy decision should be implemented in order to minimize the incidence of trauma at department of emergency care center in the country.
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Affiliation(s)
- Addis Adera Gebru
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tadesse Bekele Tafesse
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bulto LN, Dessie Y, Geda B. Magnitude, causes and characteristics of trauma victims visiting Emergency and Surgical Units of Dilchora Hospital, Eastern Ethiopia. Pan Afr Med J 2018; 30:177. [PMID: 30455806 PMCID: PMC6235504 DOI: 10.11604/pamj.2018.30.177.10969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/19/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction In developing countries, approximately sixteen hundred people die every day from all types of injuries, making injury the third most common cause of all mortalities in the region. The objective of this study was to examine the magnitude, causes and types of traumatic injuries in patients visiting Dilchora Hospital in Dire Dawa Administration of Eastern Ethiopia. Methods We conducted a cross-sectional study which was supplemented with qualitative data. Descriptive and thematic analyses were used to characterize the trauma in terms of victims, causes and types. Results A total of 382 patients were identified within a two-month period of data collection. The most common causes of traumatic injuries identified were conflict (42.67%), road traffic accidents (35.07%), falls (13.35%) and burn injuries (8.90%). Soft tissue injuries (57.6%), abrasion (29.3%) and fractures (22.3%) were the three most common types of injuries experienced. Most of the victims were males, those people in the productive age bracket and those living in urban areas. Poor road structure, poor adherence to traffic rules and the use of old and poorly maintained vehicles were the main reasons for the road traffic accidents. Substance use behaviors in urban areas and farmland boundary issues in rural areas were the common causes of conflicts, and females were the most common victims of burn injuries. Conclusion A high magnitude of injuries was observed such that, on average, six trauma victims visited the hospital each day. Conflict and road traffic accidents were the two most common causes of traumatic injuries. Poor vehicular conditions and poor road design were the main reasons identified for road traffic accident related trauma, which requires multilevel interventions.
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Affiliation(s)
- Lemma Negesa Bulto
- Haramaya University College of Health and Medical Sciences, School of Nursing and Midwifery, Harar, Ethiopia.,University of Adelaide, Adelaide Nursing School, South Australia, Australia
| | - Yadeta Dessie
- Haramaya University Colleges of Health and Medical Sciences, School of Public Health, Harar, Ethiopia
| | - Biftu Geda
- Haramaya University College of Health and Medical Sciences, School of Nursing and Midwifery, Harar, Ethiopia
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Presenting an evaluation model of the trauma registry software. Int J Med Inform 2018; 112:99-103. [DOI: 10.1016/j.ijmedinf.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/19/2022]
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Nwanna-Nzewunwa OC, Kouo Ngamby M, Shetter E, Etoundi Mballa GA, Feldhaus I, Monono ME, Hyder AA, Dicker R, Stevens KA, Juillard C. Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon. Eur J Trauma Emerg Surg 2018. [PMID: 29525968 DOI: 10.1007/s00068-018-0939-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION About 54% of deaths in low- and middle-income countries (LMICs) are attributable to lack of prehospital care. The single largest contributor to the disability-adjusted life years due to poor prehospital care is injury. Despite having disproportionately high injury burdens, most LMIC trauma systems have little prehospital organization. An understanding of existing prehospital care patterns in LMICs is warranted as a precursor to strengthening prehospital systems. METHODS In this retrospective pilot study, we collected demographic and injury characteristics, therapeutic itinerary, and transport data of patients that were captured by the trauma registry at the Central Hospital of Yaoundé (CHY) from April 15, 2009 to October 15, 2009. Bivariate and multivariate regression analyses were used to explore relationships between care-seeking behavior, method of transport, and predictor variables. RESULTS The mean age was 30.2 years (95% CI [29.7, 30.7]) and 73% were male. Therapeutic itinerary was available for 97.5% of patients (N = 2855). Nearly 18.7% of patients sought care elsewhere before CHY and 82% of such visits were at district hospitals or health clinics. Moderately (OR 1.336, p = 0.009) and severely (OR 1.605, p = 0.007) injured patients were more likely to seek care elsewhere before CHY and were less likely to be discharged home after their emergency ward visit as opposed to being admitted to the hospital for further treatment (OR 0.462, p < 0.001). Commercial vehicles provided most prehospital transport (65%), while police or ambulance transported few injured patients (7%). CONCLUSIONS Possible areas for prehospital trauma care strengthening include training lay commercial vehicle drivers in trauma care and formalizing triage, referral, and communication protocols for prehospital care to optimize timely transfer and care while minimizing secondary injury to patients.
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Affiliation(s)
- Obieze Chiemeka Nwanna-Nzewunwa
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 4th Floor, Building 1, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | | | - Elinor Shetter
- International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Isabelle Feldhaus
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | | | - Adnan A Hyder
- International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Rochelle Dicker
- Department of Surgical Critical Care, University of California Los Angeles, Los Angeles, USA
| | - Kent A Stevens
- International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Catherine Juillard
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 4th Floor, Building 1, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
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Juillard C, Dicker R, Nwanna-Nzewunwa OC, Christie SA, Carvalho M, Motwani G, Delon FND, Ngamby MK, Mballa GAE, Nsongoo P, Saidou A, Mekolo D. Analysis of a National Trauma Registry in Cameroon: Implications for Prehospital Care Strengthening. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10030-1216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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