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Hughes M, Schmidt J, Svenson J. Emergency Services Capacity of a Rural Community in Guatemala. West J Emerg Med 2022; 23:746-753. [PMID: 36205672 PMCID: PMC9541976 DOI: 10.5811/westjem.2022.7.56258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population. Methods We performed an exhaustively sampled cross-sectional survey of all healthcare facilities providing urgent and emergent care in the four largest cities surrounding Lake Atitlán using the Emergency Services Resource Assessment Tool (ESRAT). Results Of 17 identified facilities, 16 agreed to participate and were surveyed: nine private hospitals; four public clinics; and three public hospitals, including the region’s public departmental hospital. All facilities provided emergency services 24/7, and a dedicated emergency unit was available at 67% of hospitals and 75% of clinics. A dedicated physician was present in the emergency unit during the day at 67% of hospitals and 75% of clinics. Hospitals had a significantly higher percentage of available equipment compared to clinics (85% vs 54%, mean difference 31%; 95% confidence interval (CI) 23–37%; P = 0.004). There was no difference in availability of laboratory tests between public and private hospitals or between cities. Private hospitals had access to a significantly higher percentage of medications compared to clinics (56% vs 27%, mean difference 29%; 95% CI 9–49%; P = 0.024). Conclusion We found a high availability of emergency services and universal availability of personal protective equipment but a severe shortage of critical medications in clinics, and widespread shortage of pediatric equipment.
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Affiliation(s)
- Matthew Hughes
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
| | - Jessica Schmidt
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
| | - James Svenson
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
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Whitaker J, O'Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, Davies JI. Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021; 6:e004324. [PMID: 33975885 PMCID: PMC8118008 DOI: 10.1136/bmjgh-2020-004324] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles. METHODS We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment. RESULTS Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment. CONCLUSIONS Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Max Denning
- Department of Surgery and Cancer, Imperial College London, London, UK
- Stanford Graduate School of Business, Stanford University, Stanford, California, USA
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Blair KJ, Paladino L, Shaw PL, Shapiro MB, Nwomeh BC, Swaroop M. Surgical and trauma care in low- and middle-income countries: a review of capacity assessments. J Surg Res 2016; 210:139-151. [PMID: 28457320 DOI: 10.1016/j.jss.2016.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/04/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical and trauma capacity assessments help guide resource allocation and plan interventions to improve care for the injured in low- and middle-income countries (LMICs). To forge expert consensus on conducting these assessments, we undertook a systematic review of studies using five tools: (1) World Health Organization's (WHO) Guidelines for Essential Trauma Care, (2) WHO's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, (3) Personnel, Infrastructure, Procedures, Equipment, and Supplies tool, (4) Harvard Humanitarian Initiative tool, and (5) Emergency and Critical Care tool. MATERIALS AND METHODS Publications describing utilization of survey instruments to assess surgical or trauma capacity in LMICs were reviewed. Included articles underwent thematic analysis to develop recommendations. A modified Delphi method was used to establish expert consensus. Experts rated recommendations on a Likert-type scale via online survey. Consensus was defined by Cronbach's α ≥ 0.80. Recommendations achieving agreement by ≥80% of experts were included. RESULTS Two hundred and ninety-eight publications were identified and 41 included, describing evaluation of 1170 facilities across 36 LMICs. Nine recommendations were agreed upon by expert consensus: (1) inclusion of district hospitals, (2) inclusion of highest level public hospital, (3) inclusion of private facilities, (4) facility visits for on-site completion, (5) direct inspections, (6) checking surgical logs, (7) adaptation of survey instrument, (8) repeat assessments, and (9) need for increased collaboration. CONCLUSIONS Expert recommendations developed in this review describe methodology to be employed when conducting assessments of surgical and trauma capacity in LMICs. Consensus has yet to be achieved for tool selection.
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Affiliation(s)
- Kevin J Blair
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Lorenzo Paladino
- Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Pamela L Shaw
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael B Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Benedict C Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Mamta Swaroop
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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LaGrone L, Riggle K, Joshipura M, Quansah R, Reynolds T, Sherr K, Mock C. Uptake of the World Health Organization's trauma care guidelines: a systematic review. Bull World Health Organ 2016; 94:585-598C. [PMID: 27516636 PMCID: PMC4969985 DOI: 10.2471/blt.15.162214] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/29/2016] [Accepted: 02/15/2016] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines. METHODS We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines - Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes - were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines' implementation. FINDINGS We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries - 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions. CONCLUSION Although WHO's trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.
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Affiliation(s)
- Lacey LaGrone
- Harborview Injury Prevention and Research Center, Campus Box #356410, University of Washington, Seattle, WA 98104, United States of America (USA)
| | - Kevin Riggle
- Department of Surgery, University of Washington, Seattle, USA
| | | | - Robert Quansah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, USA
| | - Charles Mock
- Harborview Injury Prevention and Research Center, Campus Box #356410, University of Washington, Seattle, WA 98104, United States of America (USA)
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Miranda JJ, López-Rivera LA, Quistberg DA, Rosales-Mayor E, Gianella C, Paca-Palao A, Luna D, Huicho L. Epidemiology of road traffic incidents in Peru 1973-2008: incidence, mortality, and fatality. PLoS One 2014; 9:e99662. [PMID: 24927195 PMCID: PMC4057259 DOI: 10.1371/journal.pone.0099662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973-2008, as well as their relationship to population trends such as economic growth. METHODS AND FINDINGS Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43-5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15-0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09-1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita. CONCLUSIONS The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs.
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Affiliation(s)
- J. Jaime Miranda
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
- * E-mail:
| | - Luis A. López-Rivera
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- Programa Nacional de Empleo Juvenil Jóvenes a la Obra, Ministerio del Trabajo y Promoción del Empleo, Lima, Peru
| | - D. Alex Quistberg
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, United States of America
- Harborview Injury Prevention & Research Center, University of Washington. Seattle, Washington, United States of America
| | - Edmundo Rosales-Mayor
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro de Trastornos Respiratorios del Sueño (CENTRES), Clínica Anglo Americana, Lima, Peru
- Grupo de Investigación en Sueño (GIS), Lima, Peru
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Camila Gianella
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
| | - Ada Paca-Palao
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
| | - Diego Luna
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- Departamento de Ciencias Sociales y Políticas, Universidad del Pacífico, Lima, Peru
- Asociación Civil “Gobierno Coherente”, Lima, Peru
| | - Luis Huicho
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
- CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Miranda JJ, Rosales-Mayor E, Quistberg DA, Paca-Palao A, Gianella C, Perel P, Lopez L, Luna D, Best P, Huicho L. Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study. F1000Res 2013; 2:167. [PMID: 24358877 PMCID: PMC3814912 DOI: 10.12688/f1000research.2-167.v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/22/2022] Open
Abstract
Background: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries. Objective: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods. Methods: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider. Results: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial “golden” hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70). Conclusions: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.
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Affiliation(s)
- J Jaime Miranda
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
| | - Edmundo Rosales-Mayor
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Centro de Trastornos Respiratorios del Sueño (CENTRES), Clínica Anglo Americana, Lima, Peru ; Grupo de Investigación en Sueño (GIS), Lima, Peru ; Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - D Alex Quistberg
- Department of Epidemiology, School of Public Health, University of Washington, Seattle WA, 98195-7236, USA ; Harborview Injury Prevention & Research Center (HIPRC), University of Washington, Seattle WA, 98104-2499, USA
| | - Ada Paca-Palao
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
| | - Camila Gianella
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Luis Lopez
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Dirección de Formación Profesional y los Recursos Humanos, Ministerio del Trabajo y Promoción del Empleo, Lima, Peru
| | - Diego Luna
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Departamento de Ciencias Sociales y Políticas, Universidad del Pacífico, Lima, Peru ; Asociación Civil, Gobierno Coherente, Lima, Peru
| | - Pablo Best
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru ; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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