26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

Rotich, Claire; Staton, Catherine; Mvungi, Mark

doi:10.1136/injuryprev-2015-041654.26

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…In this study, we found that once severe illness was recognized, few participants continued home care except as a stopgap measure while gathering resources for consultation with an allopathic or traditional practitioner. In the case of injury, our findings are consistent with other East African studies reporting that few injury victims receive care at the scene of accidents or en route to a health facility, despite lengthy transports [ 39 – 41 ]. In keeping with prior studies, participants reported lack of first aid skills and supplies and expressed a desire for training [ 35 , 36 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 90%

“…Many participants were left with no other option but to use less-safe forms of transport like motorcycle taxis. Multiple studies on health care seeking in Uganda and other countries in SSA have also identified transportation as a key cause of delay [ 35 , 36 , 39 , 42 , 47 , 53 , 54 ]. An unpublished study by the GEC Research Team conducted at this study site found that the distance from the patient home to the ED significantly impacted patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda

Pickering

Dreifuss²,

Ndyamwijuka³

et al. 2022

PLoS ONE

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Objectives Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda’s rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. This study seeks to understand the emergency care seeking behavior of community members utilizing the established ED. Methods We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted until a diverse sample and theoretical saturation were obtained. An interdisciplinary and multicultural research team conducted thematic analysis based on descriptive phenomenology. Results The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 13 ED patients and 37 caregivers, on the behalf of patients when unavailable. The median duration of patients’ chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options. Conclusions Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda

Pickering

Dreifuss²,

Ndyamwijuka³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…In this study, we found that once severe illness was recognized, few participants continued home care except as a stopgap measure while gathering resources for consultation with an allopathic or traditional practitioner. In the case of injury, our findings are consistent with other East African studies reporting that few injury victims receive care at the scene of accidents or en route to a health facility, despite lengthy transports [39][40][41]. In keeping with prior studies, participants reported lack of first aid skills and supplies and expressed a desire…”

Section: Actions To Takesupporting

confidence: 88%

Getting to the Emergency Department in Time: Interviews With Patients and Their Caregivers on the Challenges to Emergency Care Utilization in Rural Uganda - a Grounded Theory Approach

Pickering

Dreifuss

Ndyamwijuka³

et al. 2021

Preprint

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Objectives Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda's rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. Methods We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted. Interviews were audio recorded, translated, and transcribed, enabling the interdisciplinary and multicultural research team to conduct thematic analysis utilizing a grounded theory approach. Results The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 37 caregivers and 13 ED patients. The majority of interviewees (mean age 38 years) were women with a primary education. The median duration of patients' chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take ; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options. Conclusions Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.

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“…As data collection was based in a large, tertiary teaching hospital, the number found in our study could be higher than what would be observed at a lower level hospital. Free ambulance transport could have also contributed to the higher proportion of ambulance utilization observed in our study, as cost of ambulance transport has been cited as a barrier to usage in other resource-limited settings [ 25 , 27 , 31 ].…”

Section: Discussionmentioning

confidence: 92%

“…Our primary method of data collection was through a questionnaire administered by native research assistants fluent in English ( S2 File ) and Sinhalese. The questionnaire was developed through combining the World Health Organization’s Injury Surveillance form, Surgeons OverSeas Assessment of Surgical Need Version 3.0, and two other questionnaires from other studies that had similar objectives but were conducted in different settings [ 19 , 23 – 25 ]. Survey questions were adapted to the local context after input from local physicians.…”

Section: Methodsmentioning

confidence: 99%

Predictors of ambulance transport to first health facility among injured patients in southern Sri Lanka

et al. 2021

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Background Injuries account for about 13% of all registered deaths in Sri Lanka and are the leading cause of admission to public hospitals. Prehospital trauma care is new to Sri Lanka, and in 2016, a free ambulance service was launched in the Western and Southern provinces. Objective The aim of this study was to identify the proportion of admitted injury patients at a tertiary hospital who used an ambulance to get to the first health facility and examine patient demographics, injury event, and injury type as predictors of ambulance transport. Methods A cross-sectional survey was administered to 405 patients who were admitted to the emergency trauma center at Teaching Hospital Karapitiya (THK) in Galle, Sri Lanka. Descriptive statistics were tabulated to summarize prehospital transportation variables. Logistic regression models were created to examine predictors of ambulance transport, and ArcGIS Pro was used to calculate the distance between injury location and first facility and THK. Results The proportion of patients with injuries who used an ambulance to get to the first health facility was 20.5%. Factors that were significantly associated with ambulance use were older age, injury mechanism, alcohol use prior to injury, location type, open wound, abrasion, and chest/abdomen injury. Distance from injury location to THK or nearest health facility were not significantly associated with ambulance transport to the first health facility. Conclusion Among lower acuity injury patients in southern Sri Lanka, 20.5% traveled in an ambulance to the first health facility, while over half used a tuk tuk. Older age and injuries at home were associated with lower odds of ambulance transport. Future studies on predictors of ambulance transport should include patients with more severe injuries, gather detailed data on care provided while in transport and examine the association between prehospital care and clinical outcomes.

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26 Evaluating access to prehospital care for traumatic brain injury patients in a resource limited setting: focus on prehospital transport

Cited by 4 publications

References 26 publications

Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda

Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda

Getting to the Emergency Department in Time: Interviews With Patients and Their Caregivers on the Challenges to Emergency Care Utilization in Rural Uganda - a Grounded Theory Approach

Predictors of ambulance transport to first health facility among injured patients in southern Sri Lanka

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