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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2024; 22:59. [PMID: 38807125 PMCID: PMC11131184 DOI: 10.1186/s12969-024-00994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). METHODS Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. RESULTS Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. CONCLUSION These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Affiliation(s)
- Naira Ikram
- Harvard Medical School, 02115, Boston, MA, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD, 20892-1102, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Utah, USA
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape, South Africa
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Aheron S, Paredes-Vincent A, Patton ME, Gross J, Medley A, Mona G, Mtimkulu N, Nkuna K, Grund JM. Improving HIV Case Finding Through Index Testing: Findings from Health Facilities in 12 Districts of South Africa, October 2019-September 2021. AIDS Behav 2024; 28:1708-1718. [PMID: 38358586 PMCID: PMC11070287 DOI: 10.1007/s10461-024-04269-3] [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] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
To assess the importance of index testing in HIV case finding, we analyzed quarterly data from October 2019 to September 2021 from 371 facilities in 12 districts in South Africa. Index testing accounted for 2.6% of all HIV tests (index and non-index) (n = 163,633), but 17.8% of all HIV-positive results, with an HIV-positivity 4-times higher than non-index testing modalities (4.1%). Despite twice as many adult females ≥ 15 years accepting index testing (n = 206,715) compared to adult males ≥ 15 years (n = 102,180), females identified fewer contacts (n = 91,123) than males (n = 113,939). Slightly more than half (51.2%) of all contacts elicited were tested (n = 163,633/319,680), while 19.7% (n = 62,978) of elicited contacts were previously diagnosed as HIV-positive and not eligible for further testing. These findings indicate index testing can be effective in increasing HIV diagnoses in South Africa. Further operational research is needed to address gaps identified in the index testing cascade, including elicitation and testing of contacts.
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Affiliation(s)
- Sarah Aheron
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa.
| | - Ariana Paredes-Vincent
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Monica E Patton
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Jessica Gross
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Amy Medley
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Gugu Mona
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | | | - Khensani Nkuna
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Jonathan M Grund
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
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Mould-Millman NK, Wogu AF, Fosdick BK, Dixon JM, Beaty BL, Bhaumik S, Lategan HJ, Stassen W, Schauer SG, Steyn E, Verster J, Wylie C, de Vries S, Jamison M, Kohlbrenner M, Mayet M, Hodsdon L, Wagner L, Snyders LO, Doubell K, Lourens D, Bebarta VS. Association of freeze-dried plasma with 24-h mortality among trauma patients at risk for hemorrhage. Transfusion 2024; 64 Suppl 2:S155-S166. [PMID: 38501905 DOI: 10.1111/trf.17792] [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: 12/29/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Blood products form the cornerstone of contemporary hemorrhage control but are limited resources. Freeze-dried plasma (FDP), which contains coagulation factors, is a promising adjunct in hemostatic resuscitation. We explore the association between FDP alone or in combination with other blood products on 24-h mortality. STUDY DESIGN AND METHODS This is a secondary data analysis from a cross-sectional prospective observational multicenter study of adult trauma patients in the Western Cape of South Africa. We compare mortality among trauma patients at risk of hemorrhage in three treatment groups: Blood Products only, FDP + Blood Products, and FDP only. We apply inverse probability of treatment weighting and fit a multivariable Cox proportional hazards model to assess the hazard of 24-h mortality. RESULTS Four hundred and forty-eight patients were included, and 55 (12.2%) died within 24 h of hospital arrival. Compared to the Blood Products only group, we found no difference in 24-h mortality for the FDP + Blood Product group (p = .40) and a lower hazard of death for the FDP only group (hazard = 0.38; 95% CI, 0.15-1.00; p = .05). However, sensitivity analyses showed no difference in 24-h mortality across treatments in subgroups with moderate and severe shock, early blood product administration, and accounting for immortal time bias. CONCLUSION We found insufficient evidence to conclude there is a difference in relative 24-h mortality among trauma patients at risk for hemorrhage who received FDP alone, blood products alone, or blood products with FDP. There may be an adjunctive role for FDP in hemorrhagic shock resuscitation in settings with significantly restricted access to blood products.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adane F Wogu
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bailey K Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julia M Dixon
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Smitha Bhaumik
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hendrick J Lategan
- Division of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Steven G Schauer
- Department of Anesthesia, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elmin Steyn
- Division of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janette Verster
- Division of Forensic Medicine, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Craig Wylie
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Shaheem de Vries
- Collaborative for Emergency Care in Africa, Cape Town, South Africa
| | - Maria Jamison
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maria Kohlbrenner
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mohammed Mayet
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Lesley Hodsdon
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Leigh Wagner
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - L' Oreal Snyders
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Karlien Doubell
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Denise Lourens
- Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Bhaumik S, Suresh K, Lategan H, Steyn E, Mould-Millman NK. The new injury severity score underestimates true injury severity in a resource-constrained setting. Afr J Emerg Med 2024; 14:11-18. [PMID: 38173687 PMCID: PMC10761343 DOI: 10.1016/j.afjem.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background The new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa. Methods This was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type. Results Of 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18-80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol. Conclusion NISS may under-estimate the 'true' injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.
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Affiliation(s)
- Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hendrick Lategan
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmin Steyn
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
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Finn J, Dixon JM, Moreira F, Herbst C, Bhaumik S, Fleischer CL, Stassen W, Beaty B, Lourens D, Verster J, Fosdick B, Lategan HJ, de Vries S, Uren G, Wylie C, Steyn E, Geduld H, Mould-Millman NK. Patterns of on-scene and healthcare system trauma deaths in the Western Cape of South Africa. World J Surg 2024; 48:320-330. [PMID: 38310308 DOI: 10.1002/wjs.12043] [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: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Injuries account for 8% or 4.4 million deaths annually worldwide, with 90% of injury deaths occurring in low- and middle-income countries. Inter-personal violence and road traffic injuries account for most injury deaths in South Africa, with rates among the highest globally. Understanding the location, timing, and factors of trauma deaths can identify opportunities to strengthen care. METHODS This is a retrospective cross-sectional secondary analysis of trauma deaths from 2021 to 2022 in the Western Cape of South Africa. Healthcare system trauma deaths were identified from a multicenter study paired with a dataset for on-scene (i.e., prior to ambulance or hospital) trauma deaths in the same jurisdictions. We describe locations, timing, injury factors, and cause of death. We assess associations between those factors. RESULTS There were 2418 deaths, predominantly young men, with most (2274, 94.0%) occurring on-scene. The most frequent mechanism of injury for all deaths was firearms (32.6%), followed by road traffic collisions (17.8%). On-scene deaths (33.2%) were significantly more likely to be injured by firearms compared to healthcare system deaths (23.6%) (p-value <0.01). Most healthcare system deaths within 4-24 h of injury occurred in a hospital emergency center. Among healthcare system decedents, half died in the emergency unit. CONCLUSIONS We identified a large burden of deaths from interpersonal violence and road traffic collisions, mostly on-scene. In addition to primary prevention, shortening delays to care can improve mortality outcomes especially for deaths occurring within 4-24 h in emergency centers.
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Affiliation(s)
- Julia Finn
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julia M Dixon
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fabio Moreira
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Celeste Herbst
- Forensic Pathology Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chelsie L Fleischer
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Services (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Denise Lourens
- Forensic Pathology Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Janette Verster
- Division of Forensic Medicine, Stellenbosch University, Cape Town, South Africa
| | - Bailey Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Shaheem de Vries
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Grace Uren
- Division of Forensic Medicine, Stellenbosch University, Cape Town, South Africa
| | - Craig Wylie
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Elmin Steyn
- Division of Surgery, Stellenbosch University, Cape Town, South Africa
| | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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van Stormbroek K, van der Merwe T, O'Brien L, Myezwa H. "Surthriving" Hand Rehabilitation: Proposing Interventions to Support Novice Occupational Therapists Working in Underserved Contexts. Occup Ther Int 2023; 2023:5562025. [PMID: 38130935 PMCID: PMC10735728 DOI: 10.1155/2023/5562025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.
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Affiliation(s)
- Kirsty van Stormbroek
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tania van der Merwe
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa O'Brien
- Swinburne University of Technology Hawthorn Campus, John Street, Hawthorn, Australia
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Matzopoulos R, Prinsloo MR, Mhlongo S, Marineau L, Cornell M, Bowman B, Mamashela TA, Gwebushe N, Ketelo A, Martin LJ, Dekel B, Lombard C, Jewkes R, Abrahams N. South Africa's male homicide epidemic hiding in plain sight: Exploring sex differences and patterns in homicide risk in a retrospective descriptive study of postmortem investigations. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002595. [PMID: 37992033 PMCID: PMC10664949 DOI: 10.1371/journal.pgph.0002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 11/24/2023]
Abstract
South Africa has an overall homicide rate six times the global average. Males are predominantly the victims and perpetrators, but little is known about the male victims. For the country's first ever study on male homicide we compared 2017 male and female victim profiles for selected covariates, against global average and previous estimates for 2009. We conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, sharp and blunt force) within and between years. 87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge being the most common cause of death. Rates were higher among males than females at all ages, and up to eight times higher for the age group 15-44 years. Provincial rates varied overall and by sex, with the highest comparative risk for men vs. women in the Western Cape Province (11.4 males for every 1 female). Male homicides peaked during December and were highest during weekends, underscoring the prominent role of alcohol as a risk factor. There is a massive, disproportionate and enduring homicide risk among South African men which highlights their relative neglect in the country's prevention and policy responses. Only through challenging the normative perception of male invulnerability do we begin to address the enormous burden of violence impacting men. There is an urgent need to address the insidious effect of such societal norms alongside implementing structural interventions to overcome the root causes of poverty, inequality and better control alcohol and firearms.
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Affiliation(s)
- Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Megan R. Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute for Lifecourse Development, Faculty of Education, Health & Human Sciences, University of Greenwich, London, United Kingdom
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lea Marineau
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brett Bowman
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Thakadu A. Mamashela
- Department of Forensic Medicine, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Nomonde Gwebushe
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Asiphe Ketelo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lorna J. Martin
- Division of Forensic Medicine and Toxicology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bianca Dekel
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health. Stellenbosch University, Cape Town, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Pathak P, Joshi SK. Epidemiology of unintentional childhood injuries in urban and rural areas of Nepal- A comparative study. PLoS One 2023; 18:e0287487. [PMID: 37847700 PMCID: PMC10581464 DOI: 10.1371/journal.pone.0287487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/06/2023] [Indexed: 10/19/2023] Open
Abstract
Unintentional injuries are one of the leading causes of ill health, disability & death among the children and young adults worldwide. As these injuries are strongly related to social determinants, the burden falls mainly upon the Low- and Middle-Income Countries (LMICs) like Nepal. Thus, the main objective was to explore the epidemiology of unintentional childhood injuries in urban and rural areas of Kavrepalanchok district. A cross sectional analytical study was done in Bethanchok rural municipality and Dhulikhel municipality of Kavrepalanchok district. The respondents were interviewed using a pretested semi-structured questionnaire. The details of injuries sustained within the past 12 months were included. A total of 667 children aged 1-16 years were surveyed, among which 26% from rural and 17.2% from urban areas had unintentional injuries in the past 12 months. Falls were the most common mode of injury in both the areas. Similarly, the proportion of burn was more in rural area (16.1%) whereas, Road Traffic Injuries were more in urban area (12.5%). Majority of the injuries occurred at home (54.5%) while the child was playing (64.1%). Factors like child's gender and place of residence affected the occurrence of unintentional injuries (p<0.05). Out of total injured children, 18 of them had not recovered and 11 were left with some form of permanent disability. As the rate and pattern of unintentional childhood injuries in the rural and urban area differ, the prevention strategies should focus on risk factors that apply to both the areas and awareness should be created among the parents and primary caregivers about the fact that childhood injuries are predictable and preventable.
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Affiliation(s)
- Pratiksha Pathak
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
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Groenewald P, Kallis N, Holmgren C, Glass T, Anthony A, Maud P, Akhalwaya Y, Afonso E, Niewoudt I, Martin LJ, De Vaal C, Cheyip M, Morof D, Prinsloo M, Matzopoulos R, Bradshaw D. Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed? S Afr Med J 2023; 113:30-35. [PMID: 37882130 PMCID: PMC11017197 DOI: 10.7196/samj.2023.v113i9.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.
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Affiliation(s)
- P Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - N Kallis
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - C Holmgren
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - T Glass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - A Anthony
- Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa.
| | - P Maud
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Y Akhalwaya
- Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Afonso
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - I Niewoudt
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L J Martin
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa.
| | - C De Vaal
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Cheyip
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - D Morof
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - M Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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10
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Groenewald P, Matzopoulos R, Afonso E, Bradshaw D. The importance of including manner of (injury) death on the death notification form. S Afr Med J 2023; 113:11-12. [PMID: 37882128 DOI: 10.7196/samj.2023.v113i9.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- P Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - R Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - E Afonso
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - D Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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11
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Azarbakhsh H, Rezaei F, Dehghani SS, Hassanzadeh J, Dehghani SP, Mirahmadizadeh A. Mortality Rate and Years of Life Lost Due to Road Traffic Accidents in Fars Province, 2004-2019. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1995-2003. [PMID: 38033827 PMCID: PMC10682593 DOI: 10.18502/ijph.v52i9.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2023]
Abstract
Background Traffic accidents are one of the most critical health problems and the ninth leading cause of death globally. We aimed to determine the Mortality rate and the number of Years of Life Lost (YLL) due to road traffic accidents. Methods In this retrospective cohort study, mortality rate and YLL due to road traffic accidents were examined in Fars province, central Iran during the years 2004-2019. Mortality statistics were collected through death registration of ministry of health and medical education for Fars Province. Age Standardized mortality Rate (ASR) was calculated and join point regression analysis carried out to examine the trend of YLL rate. Data were analyzed using Excel spreadsheet version 2016 and Join point Regression Program 4.9.0.0. Results During the 16-year study period, 25,858 deaths due to road traffic accidents occurred in the province. 79.2% (20483 cases) were in men, and 33.7% (8703 cases) were aged 15-29 years. Total YLL during the 16-year study period were 458,975 (14.6 per 1000 people) in men, 117,999 (3.8 per 1000 people) in women. According to the join point regression, the 16- year trend of YLL rate due to premature mortality was decreasing: AAPC was -4.9% (95% CI: -8.8 to -0.9; P=0.018) for male, and -3.5% (95% CI: -6.3 to-0.5; P=0.011) for female. Conclusion Considering that the number of deaths, mortality rate and YLL has decreased in Fars province during the 16 years under study. Therefore, because the mortality rate due to road traffic accidents in Iran is higher than the global average, the need for training programs for drivers, compliance with standards and retrofitting of vehicles, road safety, driving supervision and the use of seat belts are essential.
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Affiliation(s)
| | - Fatemeh Rezaei
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Jafar Hassanzadeh
- Research Center for Health Sciences, Institute of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Mould-Millman NK, Dixon J, Beaty BL, Suresh K, de Vries S, Bester B, Moreira F, Cunningham C, Moodley K, Cermak R, Schauer SG, Maddry JK, Bills CB, Havranek EP, Bebarta VS, Ginde AA. Improving prehospital traumatic shock care: implementation and clinical effectiveness of a pragmatic, quasi-experimental trial in a resource-constrained South African setting. BMJ Open 2023; 13:e060338. [PMID: 37185181 PMCID: PMC10151988 DOI: 10.1136/bmjopen-2021-060338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES This project seeks to improve providers' practices and patient outcomes from prehospital (ie, ambulance-based) trauma care in a middle-income country using a novel implementation strategy to introduce a bundled clinical intervention. DESIGN We conduct a two-arm, controlled, mixed-methods, hybrid type II study. SETTING This study was conducted in the Western Cape Government Emergency Medical Services (EMS) system of South Africa. INTERVENTIONS We pragmatically implemented a simplified prehospital bundle of trauma care (with five core elements) using a novel workplace-based, peer-to-peer, rapid training format. We assigned the intervention and control sites. OUTCOME MEASURES We assessed implementation effectiveness among EMS providers and stakeholders, using the RE-AIM framework. Clinical effectiveness was assessed at the patient level, using changes in Shock Index x Age (SIxAge). Indices and cut-offs were established a priori. We performed a difference-in-differences (D-I-D) analysis with a multivariable mixed effects model. RESULTS 198 of 240 (82.5%) EMS providers participated, 93 (47%) intervention and 105 (53%) control, with similar baseline characteristics. The overall implementation effectiveness was excellent (80.6%): reach was good (65%), effectiveness was excellent (87%), implementation fidelity was good (72%) and adoption was excellent (87%). Participants and stakeholders generally reported very high satisfaction with the implementation strategy citing that it was a strong operational fit and effective educational model for their organisation. A total of 770 patients were included: 329 (42.7%) interventions and 441 (57.3%) controls, with no baseline differences. Intervention arm patients had more improved SIxAge compared with control at 4 months, which was not statistically significant (-1.4 D-I-D; p=0.35). There was no significant difference in change of SIxAge over time between the groups for any of the other time intervals (p=0.99). CONCLUSIONS In this quasi-experimental trial of bundled care using the novel workplace rapid training approach, we found overall excellent implementation effectiveness but no overall statistically significant clinical effectiveness.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Julia Dixon
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Krithika Suresh
- Department of Biostatistics & Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Shaheem de Vries
- Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa
| | - Beatrix Bester
- Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa
| | - Fabio Moreira
- Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa
| | - Charmaine Cunningham
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Belville, South Africa
| | - Kubendhren Moodley
- Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa
| | - Radomir Cermak
- Emergency Medical Services, Western Cape Government Department of Health, City of Cape Town, South Africa
| | - Steven G Schauer
- US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas, USA
| | - Joseph K Maddry
- US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Edward P Havranek
- Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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13
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Owolabi EO, Nyamathe S, Joseph C, Khuabi LAJN, English RG, Vlok A, Erasmus E, Geduld HI, Lategan HJ, Chu KM. Mapping access to care and identification of barriers for traumatic brain injury in a South African township. J Eval Clin Pract 2023; 29:380-391. [PMID: 36415056 DOI: 10.1111/jep.13793] [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] [Received: 06/02/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE South Africa has a high traumatic injury burden resulting in a significant number of persons suffering from traumatic brain injury (TBI). TBI is a time-sensitive condition requiring a responsive and organized health system to minimize morbidity and mortality. This study outlined the barriers to accessing TBI care in a South African township. METHODS This was a multimethod study. A facility survey was carried out on health facilities offering trauma care in Khayelitsha township, Cape Town, South Africa. Perceived barriers to accessing TBI care were explored using qualitative interviews and focus group discussions. The four-delay framework that describes delays in four phases was used: seeking, reaching, receiving, and remaining in care. We purposively recruited individuals with a history of TBI (n = 6) and 15 healthcare professionals working with persons with TBI (seven individuals representing each of the five facilities, the heads of neurosurgery and emergency medical services and eight additional healthcare providers who participated in the focus group discussions). Quantitative data were analysed descriptively while qualitative data were analysed thematically, following inductive and deductive approaches. FINDINGS Five healthcare facilities (three community health centres, one district hospital and one tertiary hospital) were surveyed. We conducted 13 individual interviews (six with persons with TBI history, seven with healthcare providers from each of the five facilities, neurosurgery department and emergency medical service heads and two focus group discussions involving eight additional healthcare providers. Participants mentioned that alcohol abuse and high neighbourhood crime could lead to delays in seeking and reaching care. The most significant barriers reported were related to receiving definitive care, mostly due to a lack of diagnostic imaging at community health centres and the district hospital, delays in interfacility transfers due to ambulance delays and human and infrastructural limitations. A barrier to remaining in care was the lack of clear communication between persons with TBI and health facilities regarding follow-up care. CONCLUSION Our study revealed that various individual-level, community and health system factors impacted TBI care. Efforts to improve TBI care and reduce injury-related morbidity and mortality must put in place more community-level security measures, institute alcohol regulatory policies, improve access to diagnostics and invest in hospital infrastructures.
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Affiliation(s)
- Eyitayo O Owolabi
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa.,Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Samukelisiwe Nyamathe
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Occupational therapy, Stellenbosch University, Cape Town, South Africa
| | - Lee-Ann Jacobs-Nzuzi Khuabi
- Department of Health and Rehabilitation Sciences, Division of Occupational therapy, Stellenbosch University, Cape Town, South Africa
| | - Rene G English
- Department of Global Health, Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
| | - Adriaan Vlok
- Division of Neurosurgery, Stellenbosch University, Cape Town, South Africa
| | - Elaine Erasmus
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Heike I Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Hendrick J Lategan
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa.,Department of Surgery, University of Botswana, Gaborone, Botswana
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14
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Masterson S, Laubscher M, Maqungo S, Ferreira N, Held M, Harrison WJ, Graham SM. Return to Work Following Intramedullary Nailing of Lower-Limb Long-Bone Fractures in South Africa. J Bone Joint Surg Am 2023; 105:518-526. [PMID: 36763675 DOI: 10.2106/jbjs.22.00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Injuries are one of the leading causes of global death and disability and commonly have substantial economic implications. The economic impact of injuries is particularly pronounced in low- and middle-income countries, where 90% of injuries occur. In this study, we aimed to assess return-to-work rates of individuals who sustained a lower-limb long-bone fracture in South Africa and to identify factors that influence the ability to return to employment. METHODS This prospective cohort study was conducted across 2 tertiary trauma centers in Cape Town, South Africa. Adults who received intramedullary nail fixation for a lower-limb fracture between September 2017 and December 2018 were recruited and followed for 18 months postoperatively. The participants' return to employment was assessed at 6 and 18 months post-injury. Multivariate logistic regression was used to identify factors that influence post-injury employment. RESULTS Of the 194 participants enrolled, 192 completed follow-up. The study population had a median age of 33.0 years, and most of the participants (76.6%) were male. Seventy-five percent of the participants were employed before their injury. At 6 and 18 months post-injury, 34.4% and 56.3% of participants, respectively, were employed. Of those employed pre-injury, 70.1% had returned to work at 18 months. Multivariate regression identified increasing age, unemployment prior to injury, and working in the informal employment sector as factors that impede an individual's likelihood of working 18 months post-injury. For those in employment prior to injury, increasing age was the only factor found to impede the likelihood of returning to work following an injury. CONCLUSIONS This study highlights the profound effect that lower-limb long-bone fractures may have on an individual's ability to return to work in South Africa, with the potential to cause substantial economic impact on an individual's livelihood and that of their dependents. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Samuel Masterson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sithombo Maqungo
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Held
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - William J Harrison
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Department of Orthopaedic Trauma Surgery, Countess of Chester Hospital, Chester, United Kingdom
| | - Simon Matthew Graham
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, United Kingdom.,Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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15
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Matzopoulos R, Prinsloo M, Mhlongo S, Marineau L, Cornell M, Bowman B, Mamashela TA, Gwebushe N, Ketelo A, Martin LJ, Dekel B, Lombard C, Jewkes R, Abrahams N. South Africa's male homicide epidemic hiding in plain sight: exploring sex differences and patterns in homicide risk in a retrospective descriptive study of postmortem investigations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.02.23285093. [PMID: 36778369 PMCID: PMC9915815 DOI: 10.1101/2023.02.02.23285093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background South Africa has homicide rates six times the global average, predominantly among men, but little is known about male victims. As part of the country's first ever study of male homicide we compared 2017 male and female victim profiles for selected covariates, against global averages and previous estimates for 2009. Methods We conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, stabs and blunt force) within and between years. Findings 87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge the most common external causes. Rates were higher among males than females at all ages, and up to eight times higher among males aged 15-44 years. Provincial rates varied overall and by sex, with the highest comparative risk for men vs. women in the Western Cape Province (11.4 males for every 1 female). Male homicides peaked during December and were highest on weekends, underscoring the prominent role of alcohol as a risk factor. Significantly more males tested positive for alcohol than females. Interpretation The massive, disproportionate and enduring homicide risk borne by adult South African men highlights the negligible prevention response. Only through challenging the normative perception of male invulnerability can we begin to address the enormous burden of violence impacting men. There is an urgent need to address the insidious effect of such societal norms alongside implementing structural interventions to overcome the root causes of poverty and inequality and better control alcohol and firearms. Funding South African Medical Research Council and Ford Foundation.
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16
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Social Determinants of Seeking and Reaching Injury Care in South Africa: A Community-Based Qualitative Study. Ann Glob Health 2023; 89:5. [PMID: 36743285 PMCID: PMC9881434 DOI: 10.5334/aogh.4003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 01/28/2023] Open
Abstract
Background Timely access to quality injury care saves lives and prevents disabilities. The impact of social determinants of health on the high injury prevalence in South Africa is well documented, however, evidence of their role in accessing injury care is lacking. This study explored the social determinants of seeking and reaching injury care in South Africa. Methods This was a qualitative study involving rural and urban patients, community members, and healthcare providers in Western Cape, South Africa. Data were obtained through semi-structured interviews and focus group discussions using an interview guide informed by the four-delays framework. Inductive and deductive approaches were used for thematic analysis. Results A total of 20 individual interviews and 5 focus group discussions were conducted. There were 28 males (individual interviews: 13; focus groups: 15) and 22 females (individual interviews: 7; focus groups: 15), and their mean age was 41 (standard deviation ±15) years. Barriers to seeking and reaching injury care cut across five social determinants of health domains: healthcare access and quality; neighbourhood and environment; social and community context; education; and economic stability. The most prominent social determinants of seeking and reaching injury care were related to healthcare access and quality, including perceived poor healthcare quality, poor attitude of healthcare workers, long waiting time, and ambulance delays. However, there was a strong interconnection between these and neighbourhood and environmental determinants such as safety concerns, high crime rates, gangsterism, lack of public transportation, and social and community factors (presence/absence of social support and alcohol use). Barriers related to education and economic stability were less prevalent. Conclusion We found a substantial role of neighbourhood, social, and community factors in seeking and reaching injury care. Therefore, efforts aimed at improving access to injury care and outcomes must go beyond addressing healthcare factors to include other social determinants and should involve collaborations with multiple sectors, including the community, the police, the transport department, and alcohol regulation agencies.
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17
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Jalilian Z, Mohamadian F, Ahmadi S, Veisani Y. Death Trends and Years of Life Lost Due to Social Harms Such as Suicide, Homicide, and Addiction, Ilam Province, 2009-2019. Bull Emerg Trauma 2023; 11:167-172. [PMID: 38143526 PMCID: PMC10743323 DOI: 10.30476/beat.2023.97876.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 12/26/2023] Open
Abstract
Objective This study aimed to investigate the death trend and years of life lost (YLL) caused by social harm in Ilam province. Methods This cross-sectional study was conducted in Ilam province from 2009 to 2019. To estimate YLL, all deaths caused by suicide, homicide, and addiction were included in the study. The data were collected from the Forensic Medicine Organization. The analysis was carried out using SPSS software (version 23.0). A p-value of <0.05 was considered statistically significant. Results Between 2009 and 2019, there were 1712 occurrences of suicide, homicide, and addiction, which resulted in a total of 62,605 years of lost life (53,934 per 100,000 people). The highest frequency was related to the age group of 15-29 years, while the lowest was related to the age group of 0-14 years (p<0.001). During the studied period, men were more likely than women to commit suicide, homicide, and addiction in Ilam (p>0.439). Between 2009 and 2019, the number of suicides and homicides in Ilam province started a decreasing trend for both sexes, while the number of deaths caused by addiction was increasing. Conclusion The results of this study indicated that the age groups of 15-29 years had the highest rate of YLL caused by suicide, homicide, and addiction for both sexes. Furthermore, the findings showed that YLL decreased for suicide and homicide, but increased for addiction.
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Affiliation(s)
- Zahra Jalilian
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Fathola Mohamadian
- Department of Psychology, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sasan Ahmadi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Yousef Veisani
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
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18
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Mac Quene T, Smith L, Odland ML, Levine S, D'Ambruoso L, Davies J, Chu K. Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop. Glob Health Action 2022; 15:2067395. [PMID: 35730572 PMCID: PMC9225684 DOI: 10.1080/16549716.2022.2067395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgical healthcare in South Africa is inequitable with a considerable lack of resources in the public health sector. Identifying barriers to care and creating research priorities to mitigate these barriers can contribute to strategic interventions to improve equitable access to quality surgical care. OBJECTIVE To use the Four Delays Framework to map barriers to surgical care and identify priorities to achieve equitable and timely access to quality surgical care in South Africa. METHODS A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care, and remaining in care) was used to identify barriers that occur at each delay and the top 10 priorities for intervention. Barriers were categorised into overarching themes and schematically mapped. RESULTS Thirty-four stakeholders including health service users, health service providers, and community members participated in this exercise. In total, 34 barriers were identified with 73 connections to various delays. Specifically, 14 barriers were related to delays in seeking care, 11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28 were related to delays in remaining in care. The highest priority barriers across the delays were Lack of service provider's knowledge, training and experience, and Limited surgical outreach. The barrier Lack of decentralised services was related to all four delays. Barriers were interconnected and potentially reinforcing. CONCLUSIONS This workshop is the first of its kind to generate evidence on the delays to surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers, and priority interventions demonstrated how a multifaceted approach may be required to address delays to access. Further research focused on the identified priorities will contribute to efforts to promote equitable access to quality surgical care in South Africa.
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Affiliation(s)
- Tamlyn Mac Quene
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luné Smith
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Justine Davies
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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19
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Roshanaei G, Khoshravesh S, Abdolmaleki S, Bathaei T, Farzian M, Saatian M. Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran. BMC Emerg Med 2022; 22:210. [PMID: 36572877 PMCID: PMC9793657 DOI: 10.1186/s12873-022-00756-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/24/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020. METHODS This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be'sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be'sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24. RESULTS The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05). CONCLUSION Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.
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Affiliation(s)
- Ghodratollah Roshanaei
- grid.411950.80000 0004 0611 9280Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sahar Khoshravesh
- grid.411950.80000 0004 0611 9280Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sajjad Abdolmaleki
- grid.411950.80000 0004 0611 9280Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tayebeh Bathaei
- grid.411950.80000 0004 0611 9280Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohammadreza Saatian
- grid.411950.80000 0004 0611 9280Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran ,grid.411950.80000 0004 0611 9280School of Medicine, Hamadan University of Medical Sciences, Shaheed Fahmideh Ave, Hamadan, Islamic Republic of Iran
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20
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Korda T, Baillie-Stanton T, Goldstein LN. An observational simulation-based study of the accuracy of intercostal drain placement and factors influencing placement. Afr J Emerg Med 2022; 12:473-477. [DOI: 10.1016/j.afjem.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
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21
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Hlela M, du Toit C, Davies B. The Role of Alcohol and Drug Intoxication in Fire-Related Incidents in Africa: A Systematic Review. ANNALS OF BURNS AND FIRE DISASTERS 2022; 35:278-299. [PMID: 38680625 PMCID: PMC11041902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/03/2021] [Indexed: 05/01/2024]
Abstract
Fire-related burns contribute significantly to the global burden of burn injury and mortality. Alcohol and/or drug intoxication poses a risk to burn and fire-related injury, whether intentional or unintentional, but such evidence is scarce in the African context. This review aimed to fill the knowledge gap on health determinants of fire-related morbidity and mortality regionally by investigating the role of alcohol and drug intoxication in such events. Using key concepts, an extensive search was performed on 25 databases for relevant publications. Eligible articles were critically appraised using the appraisal tool for cross-sectional studies (AXIS tool), adapted to the review's objectives and outcomes. A total of 42 articles were included, of which less than half were solely investigating burn/fire-related events. Others indirectly mentioned burn injuries as part of larger health burdens such as injury, trauma, violence and other diseases. The measurement of alcohol and/or drug intoxication was inconsistent between studies with varying results. Alcohol and drug impairment in burn incidents in Africa requires evidence-based epidemiological research, and this review illustrated the limited scope of this topic in current literature. Routine toxicological results from post-mortem examinations were identified as important data sources and several research recommendations were provided.
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Affiliation(s)
- M.B.K.M. Hlela
- Forensic Toxicology Unit, University of Cape Town, Cape Town, South Africa
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22
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Suresh K, Dixon JM, Patel C, Beaty B, Del Junco DJ, de Vries S, Lategan HJ, Steyn E, Verster J, Schauer SG, Becker TE, Cunningham C, Keenan S, Moore EE, Wallis LA, Baidwan N, Fosdick BK, Ginde AA, Bebarta VS, Mould-Millman NK. The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa. Scand J Trauma Resusc Emerg Med 2022; 30:55. [PMID: 36253865 PMCID: PMC9574798 DOI: 10.1186/s13049-022-01041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Deaths due to injuries exceed 4.4 million annually, with over 90% occurring in low-and middle-income countries. A key contributor to high trauma mortality is prolonged trauma-to-treatment time. Earlier receipt of medical care following an injury is critical to better patient outcomes. Trauma epidemiological studies can identify gaps and opportunities to help strengthen emergency care systems globally, especially in lower income countries, and among military personnel wounded in combat. This paper describes the methodology of the “Epidemiology and Outcomes of Prolonged Trauma Care (EpiC)” study, which aims to investigate how the delivery of resuscitative interventions and their timeliness impacts the morbidity and mortality outcomes of patients with critical injuries in South Africa. Methods The EpiC study is a prospective, multicenter cohort study that will be implemented over a 6-year period in the Western Cape, South Africa. Data collected will link pre- and in-hospital care with mortuary reports through standardized clinical chart abstraction and will provide longitudinal documentation of the patient’s clinical course after injury. The study will enroll an anticipated sample of 14,400 injured adults. Survival and regression analysis will be used to assess the effects of critical early resuscitative interventions (airway, breathing, circulatory, and neurologic) and trauma-to-treatment time on the primary 7-day mortality outcome and secondary mortality (24-h, 30-day) and morbidity outcomes (need for operative interventions, secondary infections, and organ failure). Discussion This study is the first effort in the Western Cape of South Africa to build a standardized, high-quality, multicenter epidemiologic trauma dataset that links pre- and in-hospital care with mortuary data. In high-income countries and the U.S. military, the introduction of trauma databases and registries has led to interventions that significantly reduce post-injury death and disability. The EpiC study will describe epidemiology trends over time, and it will enable assessments of how trauma care and system processes directly impact trauma outcomes to ultimately improve the overall emergency care system. Trial Registration: Not applicable as this study is not a clinical trial.
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Affiliation(s)
- Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Julia M Dixon
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA
| | - Chandni Patel
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah J Del Junco
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shaheem de Vries
- Emergency Medical Services, Western Cape Government Health, Cape Town, South Africa
| | - Hendrick J Lategan
- Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmin Steyn
- Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janette Verster
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Steven G Schauer
- U.S. Army Institute of Surgical Research, San Antonio Medical Center, San Antonio, TX, USA
| | - Tyson E Becker
- Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Cord Cunningham
- Joint Trauma System, Defense Health Agency, Fort Sam Houston, San Antonio, TX, USA
| | - Sean Keenan
- Joint Trauma System, Defense Health Agency, Fort Sam Houston, San Antonio, TX, USA.,Department of Emergency Medicine, The Center for COMBAT Research, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Lee A Wallis
- Emergency Medical Services, Western Cape Government Health, Cape Town, South Africa.,Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Navneet Baidwan
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA
| | - Bailey K Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Adit A Ginde
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA.,Department of Emergency Medicine, The Center for COMBAT Research, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, 12631 E. 17th Ave, Room 2612, MS C326, Aurora, CO, 80045, USA.
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Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:693-704. [DOI: 10.7196/samj.2022.v112i8b.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background. South Africa (SA)’s high rate of interpersonal violence persists as a leading public health problem for the country. The first South African Comparative Risk Assessment Study (SACRA1) in 2000 quantified the long-term mental and physical health burden attributable to interpersonal violence by supplementing the direct injury burden of disease attributable to interpersonal violence injuries with the substantial contribution of mental health, behavioural and reproductive health consequences accruing from exposure to intimate partner violence (IPV) and child sexual abuse.
Objectives. To revise and improve these estimates by including the additional burden from other forms of child maltreatment, community violence, sexual violence by non-partners, and bullying victimisation in SA for 2000, 2006 and 2012, and trends over time.
Methods. We used comparative risk assessment methods to calculate population attributable fractions (PAFs) for interpersonal violence. This method requires inputs on the prevalence of exposure to the interpersonal violence risk factor subtypes, namely child maltreatment, bullying, IPV, sexual violence by non-partners and other community violence; the burden of related health outcomes (mortality and morbidity); and relative risks of health outcomes in individuals exposed to the risk factor v. those unexposed. We estimated the PAF for the combinations of all interpersonal violence subtypes together to estimate the burden attributable to interpersonal violence overall for 2000, 2006 and 2012.
Results. Between 2000 and 2012, there was a decrease in interpersonal violence age-standardised attributable death rates from 100 to 71 per 100 000. In the second South African Comparative Risk Assessment Study (SACRA2), estimates of the attributable disability-adjusted life years (DALYs) for interpersonal violence for the year 2000 were revised, from 1.7 million to 2 million DALYs, taking into account attributable mortality and disability from additional forms of violence. There was a decrease in DALYs attributable to interpersonal violence from 2 million in 2000 to 1.75 million in 2012, accounting for 8.5% of the total burden for SA, ranking second highest, after unsafe sex, among 18 risk factors evaluated in 2012.
Conclusion. Overall, interpersonal violence-attributable DALYs decreased substantially but remain high. The reduction in age-standardised attributable death rates indicates that some policy and social intervention aspects are effective. Further strengthening of existing laws pertaining to interpersonal violence, and other prevention measures, are needed to intensify the prevention of violence, particularly gender-based violence. Additional forms of violence included in this analysis have improved our understanding of the interpersonal violence burden, but the attributable burden in males, although exceedingly high, remains an underestimate. There is a need to improve the epidemiological data on prevalence and risks for the different types of interpersonal violence, particularly for males.
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Goldstein LN, Dawadi S, Viljoen IM. CT Utilization in a Level One Trauma Center in South Africa. Cureus 2022; 14:e29041. [PMID: 36249666 PMCID: PMC9550209 DOI: 10.7759/cureus.29041] [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] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Computed tomography (CT) imaging forms an important component in the evaluation and management of patients with traumatic injuries. Many South African emergency departments (EDs) have a significant trauma-related workload, especially in the public sector, where there are limitations in resources relating to CT scanners. It is important to gauge the impact of traumatic injuries on CT utilization. The primary objectives were to quantify the number and type of CT imaging studies trauma patients received, as well as to determine the frequency of radiologically significant findings in a level one trauma center. The secondary objectives were to determine the CT utilization rate and describe the demographics of patients who received imaging. Methods This was a retrospective, quantitative, descriptive, cross-sectional study undertaken over two months at the level one trauma center of a tertiary, academic, public sector teaching hospital in Johannesburg, South Africa. The radiology department’s picture archiving and communication system (PACS) was used to evaluate the reports of trauma patients who were referred for a CT scan. The trauma center register was used to calculate the CT utilization rate. Results There were 5,058 trauma patients seen in the two months. A total of 1,277 CT scans were performed on 843 patients. CT brain accounted for 52% of all scans performed. Radiologically significant findings were demonstrated in 407 scans (354 patients), i.e. 31.9% of scans and 42% of patients. CT chest and peripheral angiogram demonstrated radiologically significant findings in 60.5% and 50.9% of scans respectively. Assault accounted for 55.8% of the injuries sustained and road traffic accidents accounted for 33.2%. The overall CT utilization rate was 16.7% i.e. 843 out of the 5,058 trauma patients underwent a CT scan. Conclusions South Africa has a substantial trauma burden which commonly necessitates CT utilization. It is concerning that blunt and penetrating assault continues to dominate these traumatic presentations. Worldwide, there is a broad range of described CT utilization rates and the findings at this level one trauma center fall within that range. ED clinicians are encouraged to continue carefully using this scarce resource in the trauma setting.
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25
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A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa. BMC Emerg Med 2022; 22:129. [PMID: 35842578 PMCID: PMC9287876 DOI: 10.1186/s12873-022-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00688-4.
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Non-fatal injuries among boys and girls presenting to Red Cross War Memorial Children’s Hospital, Cape Town. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries.Objectives. To describe the non-fatal injuries sustained among children aged 0 - 13 years, to identify any significant sex differences by age group, cause of injury, admission status and injury severity.
Methods. The trauma unit database from 1997 to 2016 at Red Cross War Memorial Children’s Hospital, Cape Town, was utilised for this analysis. The prevalence of injuries and the boy/girl ratios with 95% confidence intervals (CIs) were reported.Results. Analysis indicated significant differences by sex for individual injury causes (transport, assault, burns, falls and other injuries), age group, injury severity and admission status. Moderately severe injuries were largely caused by burns, while severe injuries were mostly transport related. Boys had significantly higher proportions of all injury causes. The boy/girl ratio was lowest for assault (1:18), where significantly more girls aged 1 - 3 and 4 - 6 years were injured. Rape/sexual assault was 5.5 times higher for girls, with a significantly higher proportion of moderate-severity injuries (87%; 95% CI 84.7 - 89.4).
Conclusion. The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.
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Sadiki MC, Kibirige I. Strategies employed in coping with physical disabilities acquired during adulthood in rural South Africa. Afr J Disabil 2022; 11:907. [PMID: 36092476 PMCID: PMC9453136 DOI: 10.4102/ajod.v11i0.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/29/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Marubini C Sadiki
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Israel Kibirige
- Department of Mathematics, Science, and Technology Education, Faculty of Humanities, University of Limpopo, Polokwane, South Africa
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Mitra A, Okafor UB, Kaswa R, Adeniyi OV. Epidemiology of interpersonal violence at a regional hospital emergency unit in the Eastern Cape, South Africa. S Afr Fam Pract (2004) 2022; 64:e1-e5. [PMID: 35695449 PMCID: PMC9210190 DOI: 10.4102/safp.v64i1.5511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study describes the profile, mechanism and pattern of injuries, and highlights important gaps in clinicians’ consultations with patients who experienced interpersonal violence (IPV) in the predominantly black South African township of Mdantsane, Eastern Cape. Methods This retrospective cross-sectional study was conducted at the Cecilia Makiwane Regional Hospital, Mdantsane. Medical records of patients who received emergency care for trauma between 01 December 2017 and 31 March 2018 were reviewed. The records of patients identified with IPV were selected for further analysis. Data were disaggregated by demographics, mechanism of injuries and circumstances of the incidents using simple descriptive statistics. Results A total of 1064 patients reported IPV as the mechanism of injury for emergency department (ED) visits, accounting for 42.4% of all trauma-related injuries. The majority of patients with IPV were men (72.0%), unemployed (78.0%) and single (89.0%). Blunt force injury was the most common pattern of injury (53.3%); about half (50.5%) of the incidents took place in the patients’ homes. The majority of the patients (68%) knew their assailants, and a quarter of them were an intimate partner of the assailant (27.6%). The flow of patient with IPV to the ED was skewed towards the weekend (weekend effect). Also, there was an upward trend in the flow of patients with IPV to the ED from 19:00 onwards, reaching a peak at 20:00. Conclusion Interpersonal violence is the most prevalent mechanism of injury reported in this region. It is crucial to engage stakeholders in the design of interventions in order to reduce IPV-related injuries in the region.
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Affiliation(s)
- Amitabh Mitra
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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Prolonged Casualty Care: Extrapolating Civilian Data to the Military Context. J Trauma Acute Care Surg 2022; 93:S78-S85. [PMID: 35546736 DOI: 10.1097/ta.0000000000003675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource-limitations, and system configuration to U.S. military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations. METHODS We conducted a 6 month analysis of an on-going, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape ('EpiC'). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using chi-squared and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models. RESULTS 146 of 995 patients experienced PCC. The PCC group, compared to non-PCC, were more critically injured (66% vs 51%), received more critical interventions (36% vs 29%), had a greater proportionate mortality (5% vs 3%), longer hospital stays (3 vs 1 day), and higher SOFA scores (5 vs 3). The odds of 7-day mortality and a SOFA score ≥ 5 were 1.6 (OR: 1.59; 0.68, 3.74) and 3.6 (OR: 3.69; 2.11, 6.42) times higher, respectively, in PCC versus non-PCC patients. CONCLUSIONS EpiC enrolled critically injured patients with PCC who received resuscitative interventions. PCC patients had worse outcomes than non-PCC. EpiC will be a useful platform to provide on-going data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care. LEVEL OF EVIDENCE III; prospective comparative study.
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De Wet-Billings N, Frade S. Non-communicable disease comorbidities (NCDCs) among youth in South Africa: the causal contribution of not being in school or work and other socioeconomic characteristics. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hlwatika P, Hardcastle TC. Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients. SA J Radiol 2022. [DOI: 10.4102/sajr.v26i2.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Phoba N, Zunza M. Incidence and factors associated with being a victim of community assault; retrospective review of medical records in an Emergency Centre. Afr J Emerg Med 2022; 12:85-88. [PMID: 35155088 DOI: 10.1016/j.afjem.2021.11.002] [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: 04/11/2021] [Revised: 08/16/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Community assault is an interpersonal violence frequently seen in the emergency centres around South Africa. Its aim is to inflict serious injuries to a suspected perpetrator. Data has not been published in Mamelodi Regional Hospital setting whereas the cases have been observed in the emergency centre (EC). The study objectives were to determine the incidence and factors associated with being a victim of community assault in the EC in a regional hospital in Pretoria and clinical outcomes. METHODS We retrospectively reviewed the medical records of adult patients who were treated for assault in the EC of Mamelodi Regional Hospital between 5 March 2017 and 5 March 2018. EC electronic registries and medical file were used to identify all patients who presented with body injuries due to assault. RESULTS Only 807 of 1070 medical records had complete data on the exposure variables of study interest. Of the 807 participants who presented with body injury due to assault, 77 (9.544% (95% CI 7.52 to 11.57)) were due to community assault. The majority of the victims were young adults, of male gender and not married. More than half of the participants were unemployed. Young adult age doubled the odds of being a victim of community assault odds ratio (OR) 2.19 (95% CI 1.02 to 4.70). The odds of being a victim of community assault for males were 11 times the odds of females OR 11.30 (95% CI 2.74 to 46.49). Of the 77 victims of community assault, 45 (58%) were admitted, 25 (32%) were discharged after receiving treatment, 6 (8%) refused treatment and 1 (1%) died. DISCUSSION We describe the incidence of, and factors associated with, community assault in the EC of Mamelodi Regional Hospital in Pretoria. Our findings suggest that a modest incidence rate of being a victim of community assault. Young adult males are mostly the target victims of community and non-community assault. Further research is needed to understanding factors precipitating community assault and to test potential community and non-community assault prevention interventions, targeting young adult males.
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Affiliation(s)
- Ndedi Phoba
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Mamelodi Regional Hospital, Pretoria, South Africa
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Mould-Millman NK, Dixon JM, van Ster B, Moreira F, Bester B, Cunningham C, de Vries S, Beaty B, Suresh K, Schauer SG, Maddry JK, Wallis LA, Bebarta VS, Ginde AA. Clinical impact of a prehospital trauma shock bundle of care in South Africa. Afr J Emerg Med 2022; 12:19-26. [PMID: 35004137 PMCID: PMC8718736 DOI: 10.1016/j.afjem.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/23/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Patients experiencing traumatic shock are at a higher risk for death and complications. We previously designed a bundle of emergency medical services traumatic shock care (“EMS-TruShoC”) for prehospital providers in resource-limited settings. We assess how EMS-TruShoC changes clinical outcomes of critically injured prehospital patients. Methods This is a quasi-experimental educational implementation of a simplified bundle of care using a pre-post design with a control group. The intervention was delivered to EMS providers in Western Cape, South Africa. Delta shock index (heart rate divided by systolic blood pressure, reported as change from the scene to facility arrival) from the 13 months preceding intervention were compared to the 13 months post-implementation. A difference-in-differences analysis examined the difference in mean shock index change between the groups. Results Data were collected from 198 providers who treated 770 severe trauma patients. The patient groups had similar demographic and clinical characteristics at baseline. Over all time-points, both groups had an increase in mean delta shock index (worsening shock), with the largest difference occurring 4-months post-implementation (0.047 change in control arm, 0.004 change in intervention arm; −0.043 difference-in-differences, P = 0.27). In pre-specified subgroup analyses, there was a statistically significant improvement in delta shock index in the intervention arm in patients with penetrating trauma cared for by basic providers immediately post-implementation (−0.372 difference-in-differences, P = 0.02). Discussion Overall, there was no significant difference in delta shock index between the EMS-TruShoC intervention versus control groups. However, significant improvement in shock index in one subgroup suggests the intervention may be more likely to benefit penetrating trauma patients and basic providers.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- University of Colorado Denver, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
- Corresponding author.
| | - Julia M. Dixon
- University of Colorado Denver, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Bradley van Ster
- Western Cape Government, Department of Health, Emergency Medical Services, Cape Town, South Africa
| | - Fabio Moreira
- Western Cape Government, Department of Health, Emergency Medical Services, Cape Town, South Africa
| | - Beatrix Bester
- Western Cape Government, Department of Health, Emergency Medical Services, Cape Town, South Africa
| | - Charmaine Cunningham
- University of Cape Town, Department of Surgery, Division of Emergency Medicine, Cape Town, South Africa
| | - Shaheem de Vries
- Western Cape Government, Department of Health, Emergency Medical Services, Cape Town, South Africa
| | - Brenda Beaty
- University of Colorado Denver, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Krithika Suresh
- University of Colorado Denver, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Steven G. Schauer
- U.S. Army Institute of Surgical Research, Joint Base San Antonio-Ft Sam Houston, TX, USA
| | - Joseph K. Maddry
- U.S. Air Force En Route Care Research Center, Joint Base San Antonio-Lackland, TX, USA
| | - Lee A. Wallis
- University of Cape Town, Department of Surgery, Division of Emergency Medicine, Cape Town, South Africa
| | - Vikhyat S. Bebarta
- University of Colorado Denver, School of Medicine, Center for COMBAT Research, Aurora, CO, USA
| | - Adit A. Ginde
- University of Colorado Denver, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
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Hartmann L, Hamilton A, van der Merwe A, du Toit S, Xakayi W, Hunt X. Self-identified intervention priorities amongst women with road accident-acquired physical disabilities in South Africa. Afr J Disabil 2022; 11:867. [PMID: 35280967 PMCID: PMC8905417 DOI: 10.4102/ajod.v11i0.867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/19/2021] [Indexed: 11/09/2022] Open
Abstract
Background Acquiring a physical disability in adulthood necessitates a range of adjustments, with past research suggesting that some challenges encountered are unique to women. Moreover, several factors may complicate adjustment to an altered embodiment and difficulties in functioning after an accident, including insufficient rehabilitation and support services and problematic societal attitudes towards disability. In addition, women with disabilities are often excluded from health and social policy and programme development, an oversight that can result in support gaps. Objectives This article presents the self-identified priority interventions of women with road accident-acquired physical disabilities in South Africa. Methods We conducted interviews with 18 women with road accident-acquired physical disabilities. The participants were recruited via snowball sampling. Interviews were conducted by experienced interviewers, who were home language speakers of the participants’ preferred language of communication. The interview recordings were transcribed, translated, and coded by trained, independent researchers. Results Study participants identified three key areas of intervention requiring consideration in supportive intervention planning: the acute post-injury environment and healthcare infrastructure, transitional services and social inclusion interventions. These were identified as overlooked areas in which they required support to successfully adapt to limitations in functioning. Conclusion To develop inclusive, accessible, and practical policy and programming for people with disabilities, exercises like those outlined in this research – eliciting intervention ideas from lived experience – should be conducted as they highlight actionable priorities for programming.
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Affiliation(s)
- Laura Hartmann
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Alison Hamilton
- Department of Psychiatry and Biobehavioral Sciences, Faculty of Health Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
- VA Center for the Study of Healthcare Innovation Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, United States of America
| | - Amelia van der Merwe
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Stefani du Toit
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Wendy Xakayi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
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Oleribe OO, Suliman AAA, Taylor-Robinson SD, Corrah T. Possible Reasons Why Sub-Saharan Africa Experienced a Less Severe COVID-19 Pandemic in 2020. J Multidiscip Healthc 2021; 14:3267-3271. [PMID: 34858029 PMCID: PMC8630399 DOI: 10.2147/jmdh.s331847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/09/2021] [Indexed: 12/23/2022] Open
Abstract
Both scientific authorities and governments of nations worldwide were found lacking in their COVID-19 response and management, resulting in significant distrust by the general public in 2020. Scientific and medical bodies often failed to give the right counsel on the appropriate course of action on COVID-19, because proven steps were not known, while many governments around the world took ineffective, late or inappropriate COVID-19 control and containment strategies. If the 2020 COVID-19 incidence rates are to be believed, much of sub-Saharan Africa had a lower disease prevalence than expected. We put forward six factors peculiar to much of sub-Saharan Africa that may have accounted for the pandemic landscape there in 2020. We also discuss why the situation has become more serious in 2021.
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Affiliation(s)
- Obinna O Oleribe
- Office of the Director General, Nigerian Institute of Medical Research, Yabba, Lagos, Nigeria
| | - Ahmed A A Suliman
- Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.,Department of Cardiology, Shab Teaching Hospital, Khartoum, Sudan
| | - Simon D Taylor-Robinson
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
| | - Tumani Corrah
- Africa Research Excellence Fund, c/o MRC the Gambia Unit @ LSHTM, Fajara, The Gambia
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Mould‐Millman N, Dixon J, Lee M, Meese H, Mata LV, Burkholder T, Moreira F, Bester B, Thomas J, de Vries S, Wallis LA, Ginde AA. Measuring quality of pre-hospital traumatic shock care-development and validation of an instrument for resource-limited settings. Health Sci Rep 2021; 4:e422. [PMID: 34693030 PMCID: PMC8516037 DOI: 10.1002/hsr2.422] [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: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Improving the quality of pre-hospital traumatic shock care, especially in low- and middle-income countries, is particularly relevant to reducing the large global burden of disease from injury. What clinical interventions represent high-quality care is an actively evolving field and often dependent on the specific injury pattern. A key component of improving the quality of care is having a consistent way to assess and measure the quality of shock care in the pre-hospital setting. The objective of this study was to develop and validate a chart abstraction instrument to measure the quality of trauma care in a resource-limited, pre-hospital emergency care setting. METHODS Traumatic shock was selected as the tracer condition. The pre-hospital quality of traumatic shock care (QTSC) instrument was developed and validated in three phases. A content development phase utilized a rapid literature review and expert consensus to yield the contents of the draft instrument. In the instrument validation phase, the QTSC instrument was created and underwent end user and content validation. A pilot-testing phase collected user feedback and performance characteristics to iteratively refine draft versions into a final instrument. Accuracy and inter- and intra-rater agreement were calculated. RESULTS The final QTSC instrument contains 10 domains of quality, each with specific criteria that determine how the domain is measured and the level of quality of care rendered. The instrument is over 90% accurate and has good inter- and intra-rater reliability when used by trained pre-hospital provider users in South Africa. Pre-hospital provider user feedback indicates the tool is easy to learn and quick to use. CONCLUSION We created and validated a novel chart abstraction instrument that can reliably and accurately measure the quality of pre-hospital traumatic shock care. We provide a systematic methodology for developing and validating a quality of care tool for resource-limited care settings.
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Affiliation(s)
- Nee‐Kofi Mould‐Millman
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Julia Dixon
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Michael Lee
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Halea Meese
- Department of Family and Community MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Lina V. Mata
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern California, Keck School of MedicineCaliforniaLos AngelesUSA
| | - Fabio Moreira
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Beatrix Bester
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)University of Colorado DenverAuroraColoradoUSA
| | - Shaheem de Vries
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Lee A. Wallis
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
- Division of Emergency Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Adit A. Ginde
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
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Predicting mortality in trauma patients - A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital. Afr J Emerg Med 2021; 11:453-458. [PMID: 34765431 PMCID: PMC8567159 DOI: 10.1016/j.afjem.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/10/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Over 90% of trauma-related deaths worldwide, ensue in low- and middle-income countries. Multiple useful trauma scoring systems have been devised. Although validated in high-income countries, they cannot always be replicated in resource-limited countries. This study compares six trauma scores to identify the best-suited system to use for polytrauma patients in a hospital in Pretoria, South Africa. Methods This is an observational retrospective analysis of polytrauma admissions from 1 July 2016 to 31 December 2016. Data collected from patients' records from the EC of Steve Biko Academic Hospital, was analysed using Stata Release 14. Outcomes were recorded as 30-day survival, ICU– and overall hospital LOS. Scores pertaining to patient mortality, were compared in terms of sensitivity, specificity, and cut-off points based on ROC curve. Finally, for LOS Pearson correlation analysis was used. Results At the best calculated mortality prediction cut-points for the scores, the sensitivities and specificities were respectively 87% and 68% for TRISS, 81% and 61% for ISS, RTS yielded 81% and 60%, while for REMS it was 61% and 69%. The SI and RSI (cut-points used in agreement with the literature) produced sensitivities 58% and only 48%, and specificities of 73% and 83%, respectively. 45(41,7%) patients required ICU admission. Though the ICU LOS best correlated with ISS(r = 0.2710), the ICU LOS correlation coefficient was weak for all trauma scores. None of the scores had a significant p value for hospital LOS. Discussion Among the scores compared, TRISS had the highest sensitivity and NPV for mortality prediction in this South African polytrauma population. ISS correlated best with ICU LOS. However, compared to developed countries, ROC analyses & predictability of these scores fare relatively worse, and no correlation was found with hospital LOS. Therefore, we conclude that further studies are needed to ascertain a more suitable system for resource-limited settings.
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Khanyi HB, Naicker B. The use of point-of-care ultrasound in a regional emergency department in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34476962 PMCID: PMC8424764 DOI: 10.4102/safp.v63i1.5269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/03/2021] [Accepted: 06/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal. Methods A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data. Results A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation (n = 383) and extended focused assessment with sonography for trauma (n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours. Conclusion Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments.
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Affiliation(s)
- Halalisiwe B Khanyi
- Division of Emergency Medicine, School of Clinical Medicine, University of KwaZulu-Natal, Durban.
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Abafita BJ, Abate SM, Kasim HM, Basu B. Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis. Ethiop J Health Sci 2021; 30:745-754. [PMID: 33911836 PMCID: PMC8047256 DOI: 10.4314/ejhs.v30i5.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Injury has become a life threatening community health problem associated with significant mortality and morbidity worldwide. The aim of this study was to assess the burden of injury in Dilla University Hospital. Methods Institution-based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine the factors associated with hospital mortality. Results Road traffic accident was the commonest cause of injury 178(47.3%) followed by interpersonal violence 113(30.1%). Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8–25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13–0.5), length of hospitalization (LOS) 1–7 days (AOR=0.1; 95% CI, 0.01–0.8) and time of arrival >24hr were predictors of mortality in a patient with injury. Conclusion Lower extremity injury was common and mostly associated with RTA. Pre-hospital emergency medical service system and trauma registry need to be established to decrease the burden of injury.
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Affiliation(s)
- Bedru Jemal Abafita
- Dilla University, college of Health Sciences and medicine, Department of Anesthesiology, Dilla, Ethiopia
| | - Semagn Mekonnen Abate
- Dilla University, college of Health Sciences and medicine, Department of Anesthesiology, Dilla, Ethiopia
| | - Hilemariam Mulugeta Kasim
- Dilla University, college of Health Sciences and medicine, Department of Anesthesiology, Dilla, Ethiopia
| | - Bivash Basu
- University of Calcutta, medical college, department of Anesthesiology, India
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Kuronen-Stewart C, Patel N, Gabler T, Khofi-Phiri I, Nethathe GD, Loveland J. Applicability of the revised trauma score in paediatric patients admitted to a South African intensive care unit: A retrospective cohort study. Afr J Paediatr Surg 2021; 18:150-154. [PMID: 34341199 PMCID: PMC8362910 DOI: 10.4103/ajps.ajps_33_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Revised Trauma Score (RTS) is a validated tool in assessing patients in a pre-hospital setting. There are limited data describing its potential use in guiding referral to intensive care. AIMS Trauma scoring systems require appropriate validation in a local setting before effective application. This work examines the applicability of RTS to a paediatric intensive care trauma population. SETTINGS AND DESIGN A retrospective record review of trauma patients admitted to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital between 2011 and 2013 was performed. SUBJECTS AND METHODS The cohort was arbitrarily split into three subgroups based on RTS using the 33rd and 66th percentile values and groups compared. Outcome measures examined included mortality, age, gender, length of stay (LoS), duration of ventilation (DoV) and change in Glasgow Coma Scale (GCS) from admission to discharge. STATISTICAL ANALYSIS USED Categorical values examined with Fisher's exact test. Non-categorical values examined with the Kruskal-Wallis and Dunn's multiple comparisons tests. RESULTS Of 919 children admitted, 165 admissions were secondary to trauma. Data necessary for calculation of RTS were available in 91 patients. The mean RTS was 5.3, 33rd percentile was 4.7 and 66th was 5.9. DoV (P = 0.0104) and LoS (P = 0.0395) were significantly different between intermediate- and low-risk groups as was change in GCS between low-risk and both other groups (P < 0.0001). CONCLUSIONS RTS is not predictive of mortality between high-risk (RTS < 4.09) and low-risk patients (RTS > 5.67) in this population. It may be useful in predicting other outcomes such as DoV and LoS.
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Affiliation(s)
- Cameron Kuronen-Stewart
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nirav Patel
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tarryn Gabler
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isabel Khofi-Phiri
- Division of Critical Care, Intensive Care Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Gladness Dakalo Nethathe
- Division of Critical Care, Intensive Care Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Jerome Loveland
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Marle T, Mash R. Trauma patients at the Helderberg District Hospital emergency centre, South Africa: A descriptive study. Afr J Emerg Med 2021; 11:315-320. [PMID: 33996422 PMCID: PMC8100500 DOI: 10.1016/j.afjem.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Trauma is a substantial component of South Africa's burden of disease. District hospitals provide primary trauma care for a large proportion of this trauma burden, although most studies are in specialised or tertiary settings. The aim was to evaluate the profile of physical trauma patients attending the emergency centre at Helderberg District Hospital, Cape Town. METHODS An observational descriptive study was conducted between 1 January and 30 April 2019. Patients with trauma were identified from a register and systematically sampled to achieve a sample size of 377. Retrospective data from medical records was collected and analysed in the Statistical Package for Social Sciences. RESULTS Of the 14,873 patients attending the emergency centre 24.6% were trauma related and 381 folders were analysed. Of these patients 30.4% were female and 69.6% male with an average age of 27.8 years. Over 60% of patients used an ambulance to get to the hospital. Sundays were the busiest days with 23.9% of all cases. Intentional trauma accounted for 45.4% of cases and accidental injuries 49.1%. The commonest mechanisms were sharp injuries (27.6%), falls (22.0%) and blunt trauma (19.4%). Intentional trauma made up more than half of all trauma in males, was more prevalent than accidental trauma between 20 and 60 years and resulted in a higher proportion of admissions. CONCLUSION There were high levels of intentional trauma, especially involving young males over the weekend, mostly with sharp objects. This trauma burden resulted in high numbers of admissions and transfer to tertiary hospitals. Family physicians and other generalists need to be well trained in trauma resuscitation and stabilisation. District hospital need to be appropriately equipped and supplied to manage trauma. Further research is needed to identify underlying modifiable factors that can be addressed through community-orientated interventions.
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Chu KM, Marco JL, Owolabi EO, Duvenage R, Londani M, Lombard C, Parry CDH. Trauma trends during COVID-19 alcohol prohibition at a South African regional hospital. Drug Alcohol Rev 2021; 41:13-19. [PMID: 33998731 PMCID: PMC8239859 DOI: 10.1111/dar.13310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Introduction The objective of this study was to examine the relationship between trauma volume and alcohol prohibition during the COVID‐19 lockdown in South Africa. Methods This was a retrospective analysis of trauma volume from Worcester Regional Hospital in South Africa from 1 January to 28 December 2020. We compared total volume and incidence rates during five calendar periods; one when alcohol sales were allowed as per normal and four when alcohol sales were completely or partially banned. Poisson regression was used to model differences between alcohol ban and non‐ban periods. Results During the first period (pre‐COVID‐19, no ban), the trauma admission rate was 95 per 100 days, compared to 39 during the second period (complete ban 1), 74 during the third period (partial ban 1), 40 during the fourth period (complete ban 2) and 105 during the fifth period (partial ban 2). There was a 59–69% decrease in trauma volume between the no ban and complete ban 1 periods. When alcohol sales were partially reinstated, trauma volume significantly increased by 83–90% then dropped again by 39–46% with complete ban 2. By the second half of 2020, when alcohol sales were partially allowed again (partial ban 2), trauma volume increased by 163–250%, thus returning to pre‐COVID‐19 levels. Discussion and Conclusions Our study demonstrates a clear trend of decreased trauma volume during periods of complete alcohol prohibition compared to non‐ and partial alcohol bans. This finding suggests that temporary alcohol bans can be used to decrease health facility traffic during national emergencies.
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Affiliation(s)
- Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Jenna-Lee Marco
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Eyitayo Omolara Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Riaan Duvenage
- Department of Surgery, Worcester Regional Hospital, Worcester, South Africa.,Ukwanda Centre for Rural Health, Stellenbosch University, Tygerberg, South Africa
| | - Mukhethwa Londani
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Charles D H Parry
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
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van Zyl AGP, Ahmed N, Davids R. The trauma burden on a tertiary surgical intensive care unit during the lockdown period in South Africa: A retrospective observational study. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211019163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Trauma places a significant burden on scarce South African critical care resources. The impact of the lockdown period in 2020 on these resources has not been studied. Restrictions on citizen movement and alcohol sales during the lockdown period presented a unique time period to investigate the burden of trauma on a low–middle-income country tertiary hospital intensive care unit. Methods A retrospective observational analysis of all patients admitted to a tertiary hospital surgical intensive care unit during the lockdown period in 2020, compared to the same time period in 2019 and 2018. Data were analysed to detect if a significant difference was present in the number of trauma admissions, length of stay and mechanisms of trauma. Results A significant decrease in the number of trauma admissions to ICU in 2020 was observed as compared to 2018 and 2019 during the same period ( p = <0.001), with a reduction of nearly 50%. The incidence of trauma admissions was lower in all individual lockdown levels in 2020 as compared to 2018 and 2019, and the lowest incidence was recorded in level 5 of 2020. There was no difference among the length of stay of trauma patients in ICU in 2018, 2019 and 2020. There was no difference between the incidence of trauma admissions during lockdown level 3 (with and without alcohol sales) in 2020 compared to 2018. The profile of penetrating and non-penetrating trauma over the 3 years was the same ( p = 0.22). There were no interactions between years, lockdown periods and penetrating trauma ( p = 0.22). Interpretation There was a significant decrease in the trauma burden presented to the surgical ICU during the lockdown period in 2020. Levels with the strictest restrictions on movement and alcohol use had the greatest measurable impact. The decreased number of trauma patients admitted in 2020 was comparable to the national trend of decreased trauma numbers recorded in all levels of the national healthcare system.
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Affiliation(s)
- Albert GP van Zyl
- Department of Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Nadiya Ahmed
- Department of Critical Care and General Surgery, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Ryan Davids
- Department of Anaesthesiology and Critical Care, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
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The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa. World J Surg 2021; 45:2378-2385. [PMID: 33950352 DOI: 10.1007/s00268-021-06144-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). METHODS A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. RESULTS A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. CONCLUSION The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.
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Sui X, Massar K, Kessels LTE, Reddy PS, Ruiter RAC, Sanders-Phillips K. Violence Exposure in South African Adolescents: Differential and Cumulative Effects on Psychological Functioning. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:4084-4110. [PMID: 30024299 PMCID: PMC8064538 DOI: 10.1177/0886260518788363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examined the associations between different types of violence victimization and psychological functioning in South African adolescents. Both differential and cumulative effects of violence were investigated. A multi-ethnic (Black, White, people of mixed heritage, and people of Indian/Asian descent) sample of adolescents in secondary schools in the Western Cape Province (N = 1,574; boys = 46.5%, girls = 53.5%; Mage = 16 years) completed a survey on their experiences of exposure to violence (across different contexts and polyvictimization) and their levels of hopelessness, anxiety, depression, perceived stress, and suicidal ideation. The results showed that indirect and direct victimization in the community, and indirect political victimization were consistent predictors for adverse psychological functioning, whereas victimization in home and school contexts did not emerge to be significant. Polyvictimization had a consistent linear effect on psychological symptoms. Interventions in South Africa should focus on addressing the psychological effects of community and political victimization on adolescents. Adopting a holistic treatment approach would be useful to gain a comprehensive understanding of adolescents' victimization experiences and maximize the impact of support to enhance their psychological functioning.
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Saeednejad M, Zafarghandi M, Khalili N, Baigi V, Khormali M, Ghodsi Z, Sharif-Alhoseini M, O’Reilly GM, Naghdi K, Khaleghi-Nekou M, Piri SM, Rahimi-Movaghar V, Bahrami S, Laal M, Mohammadzadeh M, Fakharian E, Pirnejad H, Pahlavanhosseini H, Salamati P, Sadeghi-Bazargani H. Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran. Chin J Traumatol 2021; 24:153-158. [PMID: 33640244 PMCID: PMC8173574 DOI: 10.1016/j.cjtee.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. METHODS The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. RESULTS The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). CONCLUSION Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
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Affiliation(s)
- Mina Saeednejad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard M. O’Reilly
- National Health and Medical Research Council (NHMRC), Australia, National Trauma Research Institute, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Khaleghi-Nekou
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Bahrami
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Laal
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author.
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Hypoalbuminaemia in orthopaedic trauma patients in a rural hospital in South Africa. INTERNATIONAL ORTHOPAEDICS 2021; 46:37-42. [PMID: 33834264 DOI: 10.1007/s00264-021-05022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The deleterious effects of hypoalbuminaemia in the peri-operative period are well documented. We aimed to review serum albumin levels in a cohort of orthopaedic trauma patients to determine the prevalence of hypoalbuminaemia. Secondarily, we aimed to identify factors associated with an increased risk of hypoalbuminaemia. METHODS A retrospective cross-sectional study was performed of data collected prospectively at a regional hospital serving primarily a rural population in South Africa. RESULTS Two hundred ninety-five patients were included in the study. Twenty-nine per cent of the cohort was found to have hypoalbuminaemia. Femur neck fractures (p < 0.001), intertrochanteric fractures (p = 0.004), tibial plateau fractures (p = 0.034) and polytrauma (p = 0.013) were associated with hypoalbuminaemia. The mean albumin level was lower in HIV-positive patients when compared to HIV-negative patients (35.7 g/L vs 37.5 g/L, p = 0.007). The presence of comorbidities other than HIV, like diabetes mellitus (p = 0.001), previous pulmonary tuberculosis (p = 0.034) and chronic renal failure (p = 0.007) was associated with hypoalbuminaemia. CONCLUSION In this cohort of orthopaedic trauma patients from rural South Africa, we found a 29% prevalence of hypoalbuminaemia at the time of presentation. High-risk subgroups include patients with pre-existing comorbidities and increased age, as well as patients presenting with polytrauma, femoral neck, intertrochanteric femur or tibial plateau fractures.
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Geldenhuys MJ, Downing C. Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review. J Emerg Nurs 2021; 46:318-337. [PMID: 32389205 DOI: 10.1016/j.jen.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury. METHODS A systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool. RESULTS Nineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard. DISCUSSION Patients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.
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Bedard AF, Mata LV, Dymond C, Moreira F, Dixon J, Schauer SG, Ginde AA, Bebarta V, Moore EE, Mould-Millman NK. A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes. Int J Emerg Med 2020; 13:64. [PMID: 33297951 PMCID: PMC7724615 DOI: 10.1186/s12245-020-00324-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. MAIN BODY We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as "in-hospital mortality" as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. CONCLUSION The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.
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Affiliation(s)
- Alexander F Bedard
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA.
- United States Air Force Medical Corps, 7700 Arlington Boulevard, Falls Church, VA, 22042, USA.
| | - Lina V Mata
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Chelsea Dymond
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
- Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204, USA
| | - Fabio Moreira
- Western Cape Government, Emergency Medical Services, 9 Wale Street, Cape Town, 8001, South Africa
| | - Julia Dixon
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Steven G Schauer
- US Army Institute of Surgical Research, 3698 Chambers Rd., San Antonio, TX, 78234, USA
| | - Adit A Ginde
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Vikhyat Bebarta
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Ernest E Moore
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
- Ernest E. Moore Shock Trauma Center at Denver Health, 777 Bannock St, Denver, CO, 80204, USA
| | - Nee-Kofi Mould-Millman
- University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
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Stassen W, Alkzair S, Kurland L. Helicopter Emergency Medical Services in Trauma Does Not Influence Mortality in South Africa. Air Med J 2020; 39:479-483. [PMID: 33228898 DOI: 10.1016/j.amj.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/19/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sub-Saharan Africa carries a large trauma burden. Helicopter emergency medical services (HEMS) have been suggested to reduce prehospital time and mortality. It is not clear whether HEMS infers a mortality benefit over ground transport in South Africa. This study aimed to determine whether HEMS improved 30-day mortality over ground emergency medical services (GEMS). METHODS A retrospective, case-control study was undertaken for major trauma patients transported to a private trauma center in Johannesburg. A 1-year cohort of HEMS patients was extracted and matched to GEMS patients based on mechanism, injury severity or percentage of the total body surface area burned, age, sex, and comorbidities. The odds ratio (OR) for 30-day mortality was calculated to determine the risk of death. RESULTS A total of 822 cases (HEMS: 272 [33%], GEMS: 550 [67%]) were reviewed. We included 410 patients in the matched cohort with equal distribution between transportation modes. The OR for mortality in the total cohort was 2.69 (95% confidence interval, 1.6-4.6; P = .003) for HEMS patients, whereas in the matched cohort the OR was 1.35 (95% confidence interval, 0.5-3.4; P = .503) for patients transported by HEMS. CONCLUSION In a matched cohort of major trauma patients, HEMS does not seem to improve mortality over GEMS. These results might reflect the South African HEMS dispatch model.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | | | - Lisa Kurland
- School of Medical Sciences, Ӧrebro University, Ӧrebro, Sweden
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