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Alayande BT, Forbes C, Masimbi O, Kingpriest P, Shimelash N, Wina F, Hey MT, Philipo GS, Abahuje E, Robertson JM, Yule S, Riviello RR, Bekele A. The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review. Med Sci Educ 2024; 34:237-256. [PMID: 38510415 PMCID: PMC10948665 DOI: 10.1007/s40670-023-01898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 03/22/2024]
Abstract
Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.
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Affiliation(s)
- Barnabas T. Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Natnael Shimelash
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Matthew T. Hey
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Godfrey Sama Philipo
- Research and Patient Outcomes, College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jamie M. Robertson
- Department of Surgery, Brigham and Women’s Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Steven Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland UK
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Bekele A, Alayande BT, Powell BL, Obi N, Seyi-Olajide JO, Riviello RR, Ntirenganya F, Ameh EA, Makasa EM. National Surgical Healthcare Policy Development and Implementation: Where do We Stand in Africa? World J Surg 2023; 47:3020-3029. [PMID: 37550548 DOI: 10.1007/s00268-023-07131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational learning. METHODS Through a desk review of available African national surgical healthcare plans and written contributions from a committee comprising six African surgical policy development experts, a few key lessons from five healthcare plans were outlined and iteratively reviewed. RESULTS The current state of national surgical healthcare policies across Africa was visually mapped, and lessons from a few compelling examples are highlighted. These include the power of initiative from Senegal; regional leadership from Zambia; contextualization, and renewal of commitment from Ethiopia; multidisciplinary focus and creation of multiple implementation entry points from Nigeria; partnerships and involvement of multiple stakeholders from Rwanda; and the challenge of surgical policy financing from Tanzania. The availability of global expertise, the power of global partnerships, and the critical role of health ministries and Ministers of Health in planning and implementation have also been highlighted. CONCLUSIONS Strategic planning for surgical healthcare improvement is at various stages across the continent, with potential for countries to learn from one another. Convenings of stakeholders and Ministers of Health from countries at various stages of strategic surgical plan development, execution, and evaluation can enhance African surgical policy development through the exchange of ideas, lessons, and experiences.
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Affiliation(s)
- Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
| | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Britany L Powell
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Central Business District, Abuja, Nigeria
| | - Emmanuel M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, University of the Witwatersrand, Johannesburg, South Africa
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KingPriest PT, Alayande BT, Clement EW, Muhammed M, Egbiri JO, Shanabo M, Osayande EK, Atunrase AA, Abubakar JI, Eze DC, Adekoya S, Chiroma GB, Aikhuomogbe OM, Gaila FS, Yaga D, Thomas NN, Chukwunta CA, Hey MT, Forbes C, Riviello RR, Ismaila BO. A national perspective on exposure to essential surgical procedures among medical trainees in Nigeria: a cross-sectional survey and recommendations. BMC Med Educ 2023; 23:913. [PMID: 38037034 PMCID: PMC10691202 DOI: 10.1186/s12909-023-04847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND In sub-Saharan Africa, recent graduates from medical school provide more direct surgical and procedural care to patients than their counterparts from the Global North. Nigeria has no nationally representative data on the procedures performed by trainees before graduation from medical school and their confidence in performing these procedures upon graduation has also not been evaluated. METHODS We performed an internet-based, cross-sectional survey of recent medical school graduates from 15 accredited Federal, State, and private Nigerian medical schools spanning six geopolitical zones. Essential surgical procedures, bedside interventions and three Bellwether procedures were incorporated into the survey. Self-reported confidence immediately after graduation was calculated and compared using cumulative confidence scores with subgroup analysis of results by type and location of institution. Qualitative analysis of free text recommendations by participants was performed using the constant comparative method in grounded theory. RESULTS Four hundred ninety-nine recent graduates from 6 geopolitical zones participated, representing 15 out of a total of 44 medical schools in Nigeria. Male to female ratio was 2:1, and most respondents (59%) graduated from Federal institutions. Students had greatest practical mean exposure to bedside procedures like intravenous access and passing urethral foley catheters and were most confident performing these. Less than 23% had performed over 10 of any of the assessed procedures. They had least exposures to chest tube insertion (0.24/person), caesarean Sect. (0.12/person), and laparotomy (0.09/person). Recent graduates from Federal institutions had less procedural exposure in urethral catheterization (p < 0.001), reduction (p = 0.035), and debridement (p < 0.035). Respondents that studied in the underserved North-East and North-West performed the highest median number of procedures prior to graduation. Cumulative confidence scores were low across all graduates (maximum 25/60), but highest in graduates from Northern Nigeria and private institutions. Graduates recommended prioritizing medical students over senior trainees, using simulation-based training and constructive individualized non-toxic feedback from faculty. CONCLUSION Nigerian medical students have poor exposure to procedures and low confidence in performing basic procedures after graduation. More attention should be placed on training for essential surgeries and procedures in medical schools.
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Affiliation(s)
- Paul Tunde KingPriest
- Surgical Equity and Research Hub, Jos, Nigeria
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Barnabas Tobi Alayande
- Surgical Equity and Research Hub, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
- Harvard TH Chan School of Public Health, Boston, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Matthew T Hey
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Bashiru O Ismaila
- University of Jos, Jos, Nigeria
- Jos University Teaching Hospital, Jos, Nigeria
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Alayande BT, Forbes CW, Iradakunda J, Majyambere JP, Hey MT, Powell BL, Perl J, McCall N, Paul T, Ingabire JA, Shimelash N, Mutabazi E, Kimto EO, Danladi GM, Tubasiime R, Rickard J, Karekezi C, Makiriro G, Bigirimana SP, Harelimana JG, ElSayed A, Ndibanje AJ, Mpirimbanyi C, Masimbi O, Ndayishimiye M, Ntabana F, Haonga BT, Anderson GA, Byringyiro JC, Ntirenganya F, Riviello RR, Bekele A. Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference. Cureus 2023; 15:e43625. [PMID: 37600431 PMCID: PMC10433784 DOI: 10.7759/cureus.43625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
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Affiliation(s)
- Barnabas T Alayande
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Callum W Forbes
- Anesthesiology, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Jules Iradakunda
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Jean Paul Majyambere
- General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Butaro District Hospital, Kigali, RWA
| | - Matthew T Hey
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Brittany L Powell
- Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Juliana Perl
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Natalie McCall
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Tomlin Paul
- Educational Development and Quality Center, University of Global Health Equity, Kigali, RWA
| | - Jc Allen Ingabire
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Natnael Shimelash
- Biodesign, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - Emmanuel Mutabazi
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | | | - Claire Karekezi
- Surgery, Neurosurgery Unit, Rwanda Military Hospital, Kigali, RWA
| | - Gabriel Makiriro
- Division of Clinical Medicine, University of Global Health Equity, Kigali, RWA
| | - Simon Pierre Bigirimana
- School of Medicine, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | - James G Harelimana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | | | | | | | - Ornella Masimbi
- Simulation, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
| | | | - Frederick Ntabana
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
| | - Billy Thomson Haonga
- Orthopaedic Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Geoffrey A Anderson
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA
| | - Jean Claude Byringyiro
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Orthopedics, University Teaching Hospital of Kigali, Kigali, RWA
| | - Faustin Ntirenganya
- Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RWA
- Surgery, University Teaching Hospital of Kigali, Kigali, RWA
- NIHR Research Hub on Global Surgery, University of Rwanda, Kigali, RWA
| | - Robert R Riviello
- Trauma, Burns, and Critical Care, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
- Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
- Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Kigali, RWA
| | - Abebe Bekele
- Cardiothoracic Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA
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Sule AZ, Alayande BT, Ojo EO, Taiwo FO, Riviello RR, Chirdan LB, Ezeome ER, Mshelbwala PM, Ugwu BT, Yawe KDT. The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course. World J Surg 2023:10.1007/s00268-023-07004-6. [PMID: 37069318 PMCID: PMC10109223 DOI: 10.1007/s00268-023-07004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. METHODS A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. RESULTS The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. CONCLUSIONS Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.
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Affiliation(s)
- Augustine Z Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Barnabas T Alayande
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Femi O Taiwo
- Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lohfa B Chirdan
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Philip M Mshelbwala
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Benjamin T Ugwu
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - King-David T Yawe
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
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6
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Alayande B, Chu KM, Jumbam DT, Kimto OE, Musa Danladi G, Niyukuri A, Anderson GA, El-Gabri D, Miranda E, Taye M, Tertong N, Yempabe T, Ntirenganya F, Byiringiro JC, Sule AZ, Kobusingye OC, Bekele A, Riviello RR. Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review. Curr Trauma Rep 2022; 8:66-94. [PMID: 35692507 PMCID: PMC9168359 DOI: 10.1007/s40719-022-00229-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action. Supplementary Information The online version contains supplementary material available at 10.1007/s40719-022-00229-1.
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Affiliation(s)
- Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Alliance Niyukuri
- Hope Africa University, Bujumbura, Burundi
- Mercy Surgeons-Burundi, Research Department, Bujumbura, Burundi
- Mercy James Center for Paediatric Surgery and Intensive Care-Blantyre, Blantyre, Malawi
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Deena El-Gabri
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Mulat Taye
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ngyal Tertong
- International Fellow, Paediatric Orthopaedic Surgery Department of Orthopaedics, Sheffield Children’s Hospital, Sheffield, UK
| | - Tolgou Yempabe
- Orthopaedic and Trauma Unit, Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | - Faustin Ntirenganya
- University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital of Kigali, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Olive C. Kobusingye
- Makerere University School of Public Health, Kampala, Uganda
- George Institute for Global Health, Sydney, Australia
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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