Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. MethodsIn this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays ...

Hysteria described for more than 600 years in a variety of cultures and settings for significant adverse of public health consequences and economic implications. The aim of this study was to investigate the outbreak, determine possible risk factors and guide intervention measures. In December 25, 2012, district health office notified to Regional Health Bureau about a suspected hysteria outbreak at Kombolcha General primary school. We investigated all 50 cases and compared with 100 matched controls. For the study, detailed discussions were also undertaken with school principal, teachers, students' parents, district health officers and administrators about the event. Then data was analyzed using Epi Info version 7. Fifty cases and no death were identified. The mean age of all cases and controls was 13 with a range 9-16 year. All were girls, and mostly friends (75%). The overall attack rate of the cases were 32 per 1000 populations in all age group. Using multivariate analysis, illness were remained as risk factors, perceive evil devil force (Adjusted Odds Ratio (AOR) 5.3 with 95% CI 2.3-12), psycho stress (AOR) 2.6, 95% CI 1.14-5.72) and seeing the affected students (AOR) 2.9; 95% CI 1.1-7.78). Knowledge of modes of transmission illness (AOR) 0.48, 95% CI 0.24-0.96) and separation of girls from the environment at least for 1-2 weeks (AOR) 0.49, (95% CI 0.22-0.98) were remained as protective factors for the illness. The study confirmed the hysteria outbreak in Kombolcha Town of school girls at General Primary school. And threatening situation was associated with a socio-cultural belief with psycho stress. We recommended conducting immediate reassurance, separate therapy, create community awareness about the illness and counseling at the school could be possible to manage events.