Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

Abstract

Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3–6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo

“…The pTBI mortality rates in resource-limited countries are generally higher or even doubled compared to rich-country rates [3, 22, 23].…”

“…The problem of pTBI in poor countries has been studied and raised a lack of adequate resources for the management of severe trauma leading to high mortality [3, 22]. Solutions must adapt to local conditions so that they are efficient.…”

Assessment of nationwide emergency systems in Thailand, a middle‐income country setting with UHC

“…The hierarchy does not only determine differences in structure and staff mix (Tables and ) among the hospitals but may also include referral relationships as indicated by orderly sophistication among hospitals in the service provision for patients with acute MI, acute thrombotic stroke, or trauma (Table ). In contrast to the scarcity of these advanced services in most LMICs, nationwide availability of these services in Thai public hospitals is probably a result of the implementation of UHC since 2002 and the affordability of Thai health care systems (public expenditure on health was 12.7% of the annual government budget or less than 4% of gross domestic product [GDP]).…”

“…. In contrast to the scarcity of these advanced services in most LMICs,[19][20][21] nationwide availability of these services in Thai public hospitals is probably a result of the implementation of UHC since 2002 and the affordability of Thai health care systems (public expenditure on health was 12.7% of the annual government budget or less than 4% of gross domestic product [GDP]22 ).…”

Adaptations in pediatric anesthesia care and airway management in the resource‐poor setting

“…Children who have aspirated a foreign body often present late because the inciting event was not observed, poor management, and unavailability of diagnostic tools. Trauma, while common worldwide, is a significant cause of death in children in LMICs . In contrast to a HIC setting, prehospital care is often poor, and the ability to secure an airway in the field is often not possible.…”