Trauma care and referral patterns in Rwanda: implications for trauma system development

Background Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated. Methods A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem. Results Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were “ Training and retention of specialist staff ”, “ Health education/awareness of injury severity ”, “ Geographical coverage of referral trauma centres ”, and “ Lack of protocol for bypass to referral centres ”. The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map. Conclusion Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.

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“…Injury: Mpirimbanyi et al [ 24 ], Calland et al [ 40 ], Chokotho et al [ 39 ], Ntakiyiruta et al [ 44 ]…”

Section: Resultsmentioning

confidence: 99%

“…Most injury related procedures in University Teaching Hospital, Kigali, are for patients transferred from outside of Kigali [ 44 ]. “ Low referral trauma centre geographical coverage ” enabling provision of advanced trauma care has been shown to be sub-optimal elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

et al. 2020

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“…This prospective cross-sectional study was designed to evaluate adult injury burdens and acute care treatments at the emergency department (ED) at CHUK, the main public referral health facility and teaching hospital in Rwanda. CHUK is the largest of 4 injury referral hospitals which serve Rwanda's population of more than 6 million and one of the two located in Kigali [15] . The proportion of patients seeking injury care is estimated to be as high as 45% [16] .…”

Section: Methodsmentioning

confidence: 99%

Injury burdens and care delivery in relation to the COVID-19 pandemic in Kigali, Rwanda: A prospective interrupted cross-sectional study

Uwamahoro

Marqués

Beeman

et al. 2021

African Journal of Emergency Medicine

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Introduction Injuries cause significant burdens in sub-Saharan Africa. In Rwanda, national regulations to reduce COVID-19 altered population mobility and resource allocations. This study evaluated epidemiological trends and care among injured patients preceding and during the COVID-19 pandemic at the Centre Hospitalier Universitaire de Kigali (CHUK) in Kigali, Rwanda. Methods This prospective interrupted cross-sectional study enrolled injured adult patients (≥15 years) presenting to the CHUK emergency department (ED) from January 27th-March 21st (pre-COVID-19 period) and June 1st-28th (intra-COVID-19 period). Trained study personnel continuously collected standardized data on enrolled participants through the first six-hours of ED care. The Kampala Trauma Score (KTS) was calculated as a metric of injury severity. Case characteristics prior to and during the pandemic were compared, statistical differences were assessed using χ 2 or Fisher's exact tests. Results Data were collected from 409 pre-COVID-19 and 194 intra-COVID-19 cases. Median age was 32, with a male predominance (74.3%). Road traffic injuries (RTI) were the most common injury mechanism pre-COVID-19 (47.8%) and intra-COVID-19 (53.6%) ( p = 0.27). There was a significant increase in the number of transfer cases during the intra-COVID-19 period (52.1%) versus pre-COVID-19 (41.3%) ( p = 0.01). KTS was significantly lower among intra-COVID-19 patients ( p = 0.04), indicating higher severity of presentation. In the intra-COVID-19 period, there was a significant increase in the number of surgery consultations (40.7%) versus pre-COVID-19 (26.7%) ( p < 0.001). The number of hospital admissions increased from 35.5% pre-COVID-19 to 46.4% intra-COVID-19 ( p = 0.01). There was no significant mortality difference pre-COVID-19 as compared to the intra-COVID-19 period among injured patients ( p = 0.76). Conclusion Emergency injury care showed increased injury burden, inpatient admission and resource requirements during the pandemic period. This suggests the spectrum of disease may be more severe and that greater resources for injury management may continue to be needed during the ongoing COVID-19 pandemic in Rwanda and other similar settings.

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“…Recent studies prove that the rapid international acceptance of this method has been paramount in increasing the success rate in the treatment of idiopathic clubfoot [ 11 ]. Previous studies have shown that in developing countries, such as Ghana, medical resources are scarce, amplifying the importance of a rapid international implementation of the Ponseti method [ 12 - 15 ]. The purpose of the current study is to report on the CURE Ponseti treatment program, tenotomy rate, and relapse rate of clubfoot in Ghana, Africa.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Clubfoot Treated With Casting in Ghana

Yadavalli¹,

Hennrikus²,

Reichenbach³

2021

Cureus

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Objective: Idiopathic clubfoot deformity is a condition in pediatric orthopedics with a prevalence of 1 in 1000. This study reports the outcomes of clubfoot treatment in Ghana. Methods: The study was Institutional Review Board (IRB) approved. Patients with clubfoot were treated by the Ponseti method including weekly casting, Achilles tendon lengthening (TAL), and prolonged bracing. Data points collected included: extent of clubfoot, age, relapse, tenotomy prevalence, and number of casts. Results: Out of 1,634 patients, 72.4% were less than a year of age at the time of the first cast, 82.6% had more than eight casts prior to bracing, and 74.0% had a percutaneous Achilles tenotomy prior to the final cast placement. Only 1.2% of patients suffered a relapse. Conclusion: In Ghana, delays in seeking in treatment are common. Optimal results for the Ponseti treatment occur in children who present prior to the age of one. In the current study, 27.6% of children delayed treatment until after one. We recommend a community advocacy program to educate leaders and medical personnel about the Ponseti method. Despite a delay of treatment in 25% of the patients, there was only a 1.2% relapse rate. We recommend the Ponseti method in Ghana for children of all ages.

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Trauma care and referral patterns in Rwanda: implications for trauma system development

Cited by 15 publications

References 25 publications

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

Injury burdens and care delivery in relation to the COVID-19 pandemic in Kigali, Rwanda: A prospective interrupted cross-sectional study

Outcomes of Clubfoot Treated With Casting in Ghana

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