Timing of death at National Trauma Center, Abuja, Nigeria

Gwaram, Usman Adamu; Ameh, Emmanuel A.

doi:10.4314/ecajs.v22i3.8

Cited by 1 publication

(2 citation statements)

References 20 publications

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“…Many countries in SSA do not have a single dedicated trauma facility. Where they exist, internal disparities in access to these facilities are catalyzed by cost of care, distance from the periphery, and poor ambulance services and filter recipients of care [ 86 ]. The Trauma Society of South Africa describes levels I–IV trauma centers as major, urban, community, and primary health facilities.…”

Section: Search Resultsmentioning

confidence: 99%

“…There is no equivalent of this in West Africa, although yearly Trauma Management Courses and Advanced Trauma Operative Management Courses are held in Jos, Nigeria, and Accra, Ghana, respectively [ 98 ]. Less than 4 years ago, the National Postgraduate Medical College of Nigeria made Advanced Trauma Life Support mandatory for all surgical specialties at the membership level, in contrast to its adoption in South Africa over 30 years ago [ 86 , 99 ].…”

Section: Search Resultsmentioning

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: Search Resultsmentioning

confidence: 99%