There is a lack of injury-related economic evidence from LMICs. Current costing research has considerable variability in the costs and cost descriptions of injury and associated prevention interventions. The generalizability of these studies is limited. Yet the economic burden of injury is high, suggesting significant potential for cost savings through injury prevention. A standardized approach to economic evaluation of injury in LMICs is needed to further prioritize investing in injury prevention.

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IntroductionGiven the burden of road traffic injuries (RTIs) in South Africa, economic evaluations of prevention interventions are necessary for informing and prioritising public health planning and policy with regard to road safety.MethodsIn view of the dearth of RTI cost analysis, and in order to understand the extent to which RTI-related costs in South Africa compare with those in other low- and middle-income countries (LMICs), we reviewed published economic evaluations of RTI-related prevention in LMICs.ResultsThirteen articles were identified, including cost-of-illness and cost-effectiveness studies. Although RTI-related risk factors in South Africa are well described, costing studies are limited. There is minimal information, most of which is not recent, with nothing at all on societal costs. Cost-effective interventions for RTIs in LMICs include bicycle and motorcycle helmet enforcement, traffic enforcement, and the construction of speed bumps.DiscussionPolicy recommendations from studies conducted in LMICs suggest a number of cost-effective interventions for consideration in South Africa. They include speed bumps for pedestrian safety, strategically positioned speed cameras, traffic enforcement such as the monitoring of seatbelt use, and breathalyzer interventions. However, interventions introduced in South Africa will need to be based either on South African cost-effectiveness data or on findings adapted from similar middle-income country settings.

Injury is a leading cause of death and disability in low- and middle-income countries. Kenya has a particularly high burden of injuries, accounting for 88.4 deaths per 100,000 population. Despite recent attempts to prioritize injury prevention in Kenya, trauma care systems have not been assessed. We assessed perceptions of formal and informal district-level trauma systems through 25 qualitative semi-structured interviews and 16 focus group discussions with Ministry of Health officials, district hospital administrators, health care providers, police, and community members. We used the principles of theoretical analysis to identify common themes of prehospital and hospital trauma care. We found prehospital care relied primarily on "good Samaritans" and police. We described hospital care in terms of human resources, infrastructure, and definitive care. The interviewers repeatedly emphasized the lack of hospital infrastructure. We showed the need to develop prehospital care systems and strengthen hospital trauma care services.

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Resuscitation to euvolemia in trauma as well as in the critically ill patient, continues to be a challenge. Focused cardiac ultrasound has been shown to be a reliable tool to evaluate fluid status and to guide therapy. The present manuscript reviews the evidence supporting the use of this tool and describes the clinical applications for image-based resuscitation using echocardiogram.