Community-based wound management in a rural setting of Côte d’Ivoire

Abstract

Background Wounds are a neglected health problem in rural communities of low-income countries, mostly caused by trauma and ulcerative skin diseases including Neglected Tropical Diseases (NTDs) and associated with systemic complications and disability. Rural communities have limited access to high quality health services-based wound care. Methods We conducted a prospective observational study on wound management at three levels–community (C), health centre (HC), district hospital (DH)—in a rural community of Côte d’Ivoire. Patients with skin wounds actively identified in a house-to-house survey and passively in the health services in a defined area of the Taabo Health and Demographic Surveillance System were asked to participate and followed-up longitudinally. Endpoints were proportion of wounds closed, time to wound closure, wound size over time, frequency of secondary bacterial infection, need for recapturing after follow-up interruption, and duration of treatment stratified by health service level and wound aetiology. Results We enrolled 561 patients with 923 wounds between May 2019 and March 2020. The observation period ended in March 2021. Median age was 10 years (IQR 7–15), 63.0% of patients were male. Almost all (99.5%, 870/874) wounds closed within the observation period, 5.3% (49/923) were lost to follow-up. Wounds primarily treated in C, HC and DH closed within a median time of 10, 16 and 170 days, respectively. Median time to acute wound and chronic wound closure was 13 and 72 days, respectively. Wounds treated in C, HC and DH presented with secondary bacterial infections in 10.3% (36/350), 31.0% (133/429) and 100% (5/5) of cases, respectively. Recapturing was required in 68.3% (630/923) of wounds with participants reporting wound closure as the main reason for not attending follow-up. Conclusions We describe a wound management model based on national and WHO recommendations focusing on early identification and treatment in the community with potential for broad implementation in low-income countries. Trial registration Registration at ClinicalTrials.gov (NCT03957447).

Skin wounds in a rural setting of Côte d’Ivoire: Population-based assessment of the burden and clinical epidemiology

“…These wounds are mostly due to minor injuries, such as falls, that are frequently encountered among children, and contributed substantially to the higher wound prevalence in this population group. If treated early, these wounds heal quickly under basic standard wound management, as shown in the results of our wound management study [ 18 ]. Without prompt treatment, complications can develop, particularly in settings where access to water, sanitation and hygiene services is limited.…”

“…Training on wound assessment and on identification of specific aetiologies and complications, such as secondary bacterial infections, led to high therapeutic success rate. The treatment selected on the basis of the presumptive diagnoses provided by local healthcare personnel resulted in 99.5% of cases in wound closure [ 18 ]. Specific aetiologies (BU and yaws) received additional diagnostic tests in national and/or international laboratories.…”

“…A wound management study simultaneously implemented in the surveyed area offered high quality care for the patients identified at the survey, contributed detailed descriptions and the final diagnoses of the wounds [ 18 ].…”

“… Patients with wounds were actively (household-based survey) and passively (health services-based survey) identified in Ahondo Health Area which is part of the Taabo Health and Demographic Surveillance System (HDSS) to determine the wound prevalence and the clinical epidemiology of wounds in a rural setting of West Africa. This was combined with an observational wound management study at three health care levels–community, health centre and district hospital–aiming at early identification and treatment of wounds [ 18 ]. This approach secured appropriate treatment for all patients identified during the wound surveys.…”

“…The presumptive diagnosis was the starting point of the wound management study and after confirmation the endpoint of the clinical epidemiological / wound burden study [ 18 ].…”