Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana

Abstract

Background This study aimed to assess the availability of pediatric trauma care items (i.e. equipment, supplies, technology) and factors contributing to deficiencies in Ghana. Methods Ten universal and 9 pediatric-sized items were selected from the World Health Organization’s Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical and biomedical engineering staff were used to assess item availability at 40 purposively sampled district, regional and tertiary hospitals in Ghana. Results Hospital assessments demonstrated marked deficiencies for a number of essential items (e.g. basic airway supplies, chest tubes, blood pressure cuffs, electrolyte determination, portable Xray). Lack of pediatric-sized items resulting from equipment absence, lack of training, frequent stock-outs and technology breakage were common. Pediatric items were consistently less available than adult-sized items at each hospital level. Conclusion This study identified several successes and problems with pediatric trauma care item availability in Ghana. Item availability could be improved, both affordably and reliably, by better organization and planning (e.g. regular assessment of demand and inventory, reliable financing for essential trauma care items). In addition, technology items were often broken. Developing local service and biomedical engineering capability was highlighted as a priority to avoid long periods of equipment breakage.

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

“…Findings from high-income countries suggest that dedicated systems of care for injured children can avert deaths and disability (72,76). In LMICs, pediatric-specific trauma care resources and expertise are more often deficient than those for general trauma care (2,11,75); planning and organizing care for injured children should be a priority area for research and system development, given the large burden of pediatric injury in LMICs.…”

Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience

“…However, particular care should be taken when deciding to operate on an infant or determining that a child requires an airway. The perioperative capacity of many hospitals and humanitarian projects in LMICs is extremely limited [15]. As a result, teams often work with few physical resources and rely on task-sharing [47,48].…”

“…A number of barriers to surgical care prevent children from receiving treatment in LMICs, including critical resource deficiencies, insufficient pediatric-specific supplies, and a lack of national government and international aid support [8–15]. As a result, unmet surgical needs in children, even for common conditions (e.g., burns, hernias, appendicitis), result in a large number of preventable deaths and even greater disability [5,13,16–18].…”

Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

“…The hospital serves a third of the country's population and performs more than 25,000 operations per year. While local quality improvement initiatives and several university collaborations have improved hospital care processes, significant deficiencies remain, including an inefficient referral system, limited access to diagnostic imaging and overwhelmed operative services [3,17,18]. Consequently, late presentation and limited evaluation are common and complicate the provision of timely surgical care [19].…”

“…This burden falls disproportionately on low- and middle-income countries (LMICs) that are least equipped to provide necessary care due to critical deficiencies in personnel, diagnostics and supplies [2,3]. Recent recognition of this important public health problem has prompted initiatives to strengthen the surgical health systems in LMICs [4].…”