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31 Developing and evaluating trauma care systems in low- and middle-income countries (LMICs): experiences in africa
  1. Adnan A Hyder1,
  2. Isaac Botchey1,
  3. Amber Mehmood1,
  4. Olive Kobusingye2,
  5. Junaid Razzak1
  1. 1Johns Hopkins International Injury Research Unit, USA
  2. 2Makerere University School of Public Health, Uganda


Background Injuries kill more than 5 million people around the world each year. More than 90% of these deaths occur in low- and middle-income countries (LMICs), and road traffic injury (RTI) is the most common mechanism of fatal injury, with an estimated 1.24 million deaths per yea. RTI fatality rates are two to three times higher in LMICs than in high-income countries (HICs), due to a variety of factors including differences in road construction, vehicle conditions, and the existence and enforcement of laws regulating safety behaviours. An additional factor is the lack or poor quality of trauma care systems in many LMICs. As a consequence, fatality rates for the moderately and severely injured are more than 50% higher in LMIC than in the United States, and an estimated 1.73 million lives could be saved each year if trauma care capabilities could be brought to par with those of HICs.

Moderator Dr. Adnan A. Hyder, Johns Hopkins International Injury Research Unit (JH-IIRU, USA)

  • Welcome and overview of trauma in low- and middle-income countries – Dr. Adnan A. Hyder, Johns Hopkins International Injury Research Unit, USA

  • Talk 1: Efforts to improve the care of the injured in Kenya – successes and struggles – Dr. Isaac Botchey, Johns Hopkins International Injury Research Unit, USA

    • Abstract: Kenya is a LMIC in East Africa with a population of 40 million people. Injury is the second leading cause of death after HIV/AIDS in Kenya and the number of people injured is on the rise. There is a lack of coordinated, integrated pre-hospital, hospital and rehabilitative care in Kenya. The Bloomberg Philanthropies Global Road Safety Program (BPGRSP) was a five-year, ten-country effort to reduce the mortality associated with RTIs. The goal of the Johns Hopkins International Injury Research Unit’s (IIRU) trauma care activities in Kenya was to improve the care of the injured through a systematic, multi-faceted, evidence-based approach. A literature review and a trauma system profile was performed based on which a nine point plan was set to achieve our objective. The nine-point plan was centred on stakeholder engagement, trauma registry development and implementation; pre-hospital and hospital care training as well as strengthening of trauma-care legislation.

  • Talk 2: Role of trauma registries to improve quality of care in developing countries – case studies from three different settings – Dr. Amber Mehmood, Johns Hopkins International Injury Research Unit, USA

    • Abstract: Trauma registries play an important role in performance improvement and hospital-based injury surveillance. Case studies from Pakistan, Kenya and Kampala are presented with details about inclusion, exclusion criteria, data collection platform, implementation model, funding sources and stakeholder engagement. All three registries used electronic platforms, however implementation strategies differed. Dedicated trauma registry personnel results in reliable capture of cases, complete follow up of patients and better quality of data but has higher cost of operation. Trauma registries not only helped in measuring hospital injury burden but also helped documenting the care processes with potentially impactful solutions. Implementation of trauma registries may cause both direct and indirect positive impact on trauma care in the hospital regardless of method of implementation. Long term and sustainable impact could only be seen with strong support from key hospital administrators.

  • Talk 3: Developing an internet-based traumatic brain injury registry in Uganda – Dr. Olive Kobusingye, Makerere University School of Public Health, Uganda

    • Abstract: The primary aim of this review was to define core variables for an internet-based data registry focused on TBI in Uganda. A comprehensive review was conducted. Six databases including PubMed/Medline, Embase, Scopus, Cochrane Reviews, System for Information on Grey Literature and Global Health Ovid were searched for literature pertaining to TBI in the African region and TBI registries in low-and middle-income countries. Thirty-five articles were identified as relevant to the focus of inquiry. The majority of the articles were from Nigeria, followed by South Africa and Tunisia. Few included definition used to define TBI. The most commonly collected core variables were demographics, injury event, initial assessment, emergency department care, in-patient care and outcome at hospital discharge.

  • Discussant: Steps forward: what are the best “systems” to care for the injured in low-resource settings -- Dr. Junaid Razzak, Johns Hopkins International Injury Research Unit, USA

  • Q&A -- Dr. Adnan A. Hyder, Johns Hopkins International Injury Research Unit, USA

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