Introducing a Trauma Registry in Mozambique: An Ethics Case Study

Hamadani, Fadi; Neves, Otilia; Mocumbi, Ana Olga; Razek, Tarek; Khwaja, Kosar; Fata, Paola; Beckett, Andrew; Jethá, Eunice; Deckelbaum, Dan

doi:10.4236/ijcm.2014.516127

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…Contextualized, informal lay provider networks as employed on a small scale by some parts of Madagascar, Uganda, Ghana, and southern Nigeria [ 71 – 75 ] can be strengthened to decrease prehospital trauma mortality rates; however, this should not be used to excuse the absence of tier-2 systems which ideally represent the highest quality of prehospital surgical care [ 76 ]. The percentage of injured patients that arrive at health facilities by ambulance in SSA varies widely by country and facility, from 59% in Ethiopia [ 77 ] to 5.9% in Zambia [ 78 ] and 5% in Mozambique [ 79 ].…”

Section: Search Resultsmentioning

confidence: 99%

“…South Africa, Malawi, Uganda, Cameroon, Kenya, Ghana, Rwanda, Tanzania, and Zambia [ 168 ] have established trauma registries. Botswana [ 165 ], Nigeria [ 164 ], Ethiopia [ 166 ], and Mozambique [ 79 , 167 ] have registries at different levels of implementation. Quality of data collection is a challenge in many countries [ 169 ].…”

Section: Future Directions and Recommendationsmentioning

confidence: 99%

“…Access to the highest quality trauma care can only be possible in the presence of continued quality improvement [ 79 , 164 – 168 ]. The absence of trauma registries feeds disparities in the quality of trauma care by denying trauma systems information that can focus efforts on parts of the system in greatest need of improvement.…”

Section: Future Directions and Recommendationsmentioning

confidence: 99%

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Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Alayande,

Chu,

Jumbam

et al. 2022

Curr Trauma Rep

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Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action.

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Section: Search Resultsmentioning

confidence: 99%

Section: Future Directions and Recommendationsmentioning

confidence: 99%

Section: Future Directions and Recommendationsmentioning

confidence: 99%

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Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Alayande,

Chu,

Jumbam

et al. 2022

Curr Trauma Rep

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“…Furthermore, a trauma registry has been establish at HCM in partnership with McGill University. 9 In the general surgery department, there is interest in training trauma and critical care surgeons in order to support the emerging trauma care system in Mozambique.…”

Section: Discussionmentioning

confidence: 99%

General surgical services at an urban teaching hospital in Mozambique

Snyder

Amado

Jacobe

et al. 2015

Journal of Surgical Research

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Background As surgery becomes incorporated into global health programs, it will be critical for clinicians to take into account already existing surgical care systems within low-income countries. In order to inform future efforts to expand the local system and systems in comparable regions of the developing world, we aimed to describe current patterns of surgical care at a major urban teaching hospital in Mozambique. Methods We performed a retrospective review of all general surgery patients treated between August 2012 and August 2013 at Hospital Central Maputo in Maputo, Mozambique. We reviewed emergency and elective surgical logbooks, inpatient discharge records, and death records to report case volume, disease etiology, and mortality. Results There were 1,598 operations (910 emergency, 688 elective) and 2,606 patient discharges during our study period. The most common emergent surgeries were for non-trauma laparotomy (22%) followed by all trauma procedures (18%), while the most common elective surgery was hernia repair (31%). The majority of lower extremity amputations were above knee (69%). The most common diagnostic categories for inpatients were infectious (31%), trauma (18%), hernia (12%), neoplasm (10%), and appendicitis (5%). The mortality rate was 5.6% (146 deaths), approximately half of which were related to sepsis. Conclusions Our data demonstrate the general surgery caseload of a large, academic, urban training and referral center in Mozambique. We describe resource limitations that impact operative capacity, trauma care, and management of amputations and cancer. These findings highlight challenges that are applicable to a broad range of global surgery efforts.

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“…About 69% of the country's 26.5 million residents live in rural areas, 31% in urban areas, and there is an increasing urbanization rate at 3% annually [9][10][11]. Consequently, there has been a rise in motorization, population density, and an increase in urban injury patterns, including motor vehicle collisions [12,13]. These developments have put further strain on an already stretched health system.…”

Section: Introductionmentioning

confidence: 99%

Trauma Surveillance and Registry Development in Mozambique: Results of a 1‐Year Study and the First Phase of National Implementation

et al. 2019

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Background Mozambique has had no policy-driven trauma system and no hospital-based trauma registries, and injury was not a public health priority. In other low-income countries, trauma system implementation and trauma registries have helped to reduce mortality from injury by up to 35%. In 2014, we introduced a trauma registry in four hospitals in Maputo serving 18,000 patients yearly. The project has since expanded nationally. This study summarizes the challenges, results, and lessons learned from this large national undertaking. Methods Between October 2014-September 2015, we implemented a trauma registry at four hospitals in Maputo. In October 2015, the project began to be expanded nationally. Physicians and allied health professionals at each hospital were trained to implement the registry, and each identified and trained data collectors. We conducted semi-structured interviews with the key stakeholders of this project to identify the challenges, results, and creative solutions implemented for the success of this project. Results Most participants identified the importance of having a trauma registry and its usefulness in identifying gaps in trauma care. The registry identified that less than 5% of injured patients arrived by ambulance, which served as evidence for the need for a prehospital system, which the Ministry of Health had already begun implementing. Participants also highlighted how the registry has allowed for a structured clinical approach to patients, ensuring that severely injured patients are identified early. Challenges reported included the high rates of missing data, the difficulty in establishing a streamlined flow of trauma patients within each hospital, and the bureaucratic challenges faced when attempting to improve capacity for trauma care at each hospital by introducing a trauma bay and new technologies. Participants identified the need to improve data completeness, to disseminate the results of the project nationally and internationally, to improve inter-divisional cooperation, and to continue educating health providers on the importance of registries. Participants also identified political instabilities in the region as a potential source of challenge in expanding the project nationally; they also identified the lack of uniform resource allocation and low personnel in many areas, especially rural, as a major burden that would need to be overcome. Conclusion Introduction of a trauma registry system in Mozambique is feasible and necessary. Initial findings provide insight into the nature of traumas seen in Maputo hospitals, but also underscore future challenges, especially in minimizing missing data, utilizing data to develop evidence-based trauma prevention policies, and ensuring the sustainability of these efforts by ensuring continued governmental support, education, and resource allocation. Many of these measures are being undertaken.

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Introducing a Trauma Registry in Mozambique: An Ethics Case Study

Cited by 5 publications

References 21 publications

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

General surgical services at an urban teaching hospital in Mozambique

Trauma Surveillance and Registry Development in Mozambique: Results of a 1‐Year Study and the First Phase of National Implementation

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