Assessing trauma care health systems in low- and middle-income countries, a protocol for a systematic literature review and narrative synthesis

Abstract

Background Trauma represents a major global health problem projected to increase in importance over the next decade. The majority of deaths occur in low- and middle-income countries (LMICs) where survival rates are lower than their high-income country (HIC) counterparts. Health system level changes in care for injured patients have been attributed to significant improvements in care quality and outcomes in HIC settings. There is a need for further research to assess trauma care health systems in LMICs to inform health system strengthening for the care of the injured. This study aims to conduct a narrative synthesis of a systematic search of the literature on the assessment of trauma care health systems in LMICs in order to inform the further development of trauma care health system assessment. Methods The review will include primary quantitative, qualitative or mixed method studies and secondary literature reviews. No restriction will be placed on language or date. Reports and publications identified from the grey literature including from relevant national and international health organisations will be included. Articles will be screened by two independent reviewers with a third reviewer resolving any persisting disagreement. The search will reveal heterogenous studies not suitable for meta-analysis. A narrative synthesis of the identified papers will be conducted to identify key methodological ideas and paradigms used to assess trauma care health systems. The analysis will consider how the differing methodological approaches could be adopted to understand barriers and delays to seeking, reaching and receiving care within a “Three Delays” framework. An iterative approach will be adopted to categorise identified articles, with the results presented as both within and across study analysis. Discussion The results of the review will be disseminated through publication in a peer-reviewed academic journal. The study forms part of a PhD project. The results will inform the development of a trauma care health system assessment applicable to LMICs. As this is a review of secondary data, no formal ethical approval is required. Systematic review registration PROSPERO CRD42018112990 Electronic supplementary material The online version of this article (10.1186/s13643-019-1075-8) contains supplementary material, which is available to authorized users.

Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

“… 48 The study was registered with PROSPERO (CRD42018112990) and the protocol previously published. 49 …”

The Plastic Surgery Workforce and Its Role in Low-income Countries

“…3 , 13 Facial clefts, although not a proportionally large component of the GBD, are nevertheless a relatively common problem amenable to plastic surgical care that otherwise is devastating to the affected individuals. 14 From the GBD study, we know that these 3 entities represent a high proportion of the burden in LICs, and none are expected to diminish over the next several years. Additionally, while our study focuses on essential surgical conditions, there are also a host of cancer diagnoses that require surgery and potential intervention by a plastic surgeon for reconstruction for both functional and cosmetic purposes.…”

Mental Wellbeing and Boosting Resilience to Mitigate the Adverse Consequences of the COVID-19 Pandemic: A Critical Narrative Review

“…The importance of mental health and social support has been acknowledged as an important health aspect in previous pandemics (Reynolds et al, 2007; Shultz et al, 2015) and providers should anticipate an uptick in utilization both during the lockdown and after the end of the lockdown (Meredith et al, 2011; Shigemura et al, 2020; Terhakopian & Benedek, 2007). However, most of these studies are based on high-income countries’ responses and studies, which does not take into consideration the cultural aspects of mental health, its institutionalization and means (Sarikhani et al, 2021; Whitaker et al, 2019).…”

“…Some cultures and countries may be disproportionally more vulnerable to adverse mental and physical health consequences (Mitchell & Li, 2021; Sarikhani et al, 2021; Whitaker et al, 2019). In many countries and cultures, mental health is not a topic that is discussed in the open and stigma remains widespread (Lauber & Rössler, 2007; Loya et al, 2010; Mascayano et al, 2015).…”