CC BY 4.0 · Surg J (N Y) 2021; 07(04): e281-e285
DOI: 10.1055/s-0041-1732351
Review Article

Trauma Care in Low- and Middle-Income Countries

Dhurka Shanthakumar
1   Department of Surgery, Whipps Cross Hospital, London, United Kingdom
,
Anna Payne
2   Department of Surgery, Royal London Hospital, London, United Kingdom
,
Trish Leitch
3   Department of Surgery, St George's Hospital, London, United Kingdom
,
Maryam Alfa-Wali
2   Department of Surgery, Royal London Hospital, London, United Kingdom
› Author Affiliations
Funding None.

Abstract

Background Trauma-related injury causes higher mortality than a combination of prevalent infectious diseases. Mortality secondary to trauma is higher in low- and middle-income countries (LMICs) than high-income countries. This review outlines common issues, and potential solutions for those issues, identified in trauma care in LMICs that contribute to poorer outcomes.

Methods A literature search was performed on PubMed and Google Scholar using the search terms “trauma,” “injuries,” and “developing countries.” Articles conducted in a trauma setting in low-income countries (according to the World Bank classification) that discussed problems with management of trauma or consolidated treatment and educational solutions regarding trauma care were included.

Results Forty-five studies were included. The problem areas broadly identified with trauma care in LMICs were infrastructure, education, and operational measures. We provided some solutions to these areas including algorithm-driven patient management and use of technology that can be adopted in LMICs.

Conclusion Sustainable methods for the provision of trauma care are essential in LMICs. Improvements in infrastructure and education and training would produce a more robust health care system and likely a reduction in mortality in trauma-related injuries.



Publication History

Received: 28 July 2020

Accepted: 21 May 2021

Article published online:
22 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Reynolds TA, Stewart B, Drewett I. et al. The impact of trauma care systems in low- and middle-income countries. Annu Rev Public Health 2017; 38: 507-532
  • 2 Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 1998; 44 (05) 804-812 , discussion 812–814
  • 3 Ozgediz D, Jamison D, Cherian M, McQueen K. The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 2008; 86 (08) 646-647
  • 4 Stelfox HT, Joshipura M, Chadbunchachai W. et al. Trauma quality improvement in low and middle income countries of the Asia-Pacific region: a mixed methods study. World J Surg 2012; 36 (08) 1978-1992
  • 5 Murray CJ, Barber RM, Foreman KJ. et al; GBD 2013 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet 2015; 386 (10009): 2145-2191
  • 6 Mock C, Abantanga F, Goosen J, Joshipura M, Juillard C. Strengthening care of injured children globally. Bull World Health Organ 2009; 87 (05) 382-389
  • 7 Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Organ 2009; 87 (04) 246-246a
  • 8 Sakran JV, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med 2012; 20: 64
  • 9 Murray CJ, Vos T, Lozano R. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2197-2223
  • 10 The World Bank. Classifying countries by income. Published 20019. Accessed December 1, 2020 at: https://datatopics.worldbank.org/world-development-indicators/stories/the-classification-of-countries-by-income.html
  • 11 Haider A, Scott JW, Gause CD. et al. Development of a unifying target and consensus indicators for global surgical systems strengthening: proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance). World J Surg 2017; 41 (10) 2426-2434
  • 12 Anand M. Health status and health care services in Uttar Pradesh and Bihar: a comparative study. Indian J Public Health 2014; 58 (03) 174-179
  • 13 de Snyder VN, Friel S, Fotso JC. et al. Social conditions and urban health inequities: realities, challenges and opportunities to transform the urban landscape through research and action. J Urban Health 2011; 88 (06) 1183-1193
  • 14 Kruk ME, Wladis A, Mbembati N. et al. Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 2010; 7 (03) e1000242
  • 15 Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M. Evaluation of trauma care capabilities in four countries using the WHO-IATSIC guidelines for essential trauma care. World J Surg 2006; 30 (06) 946-956
  • 16 Mock C, Kobusingye O, Anh V, Afukaar F, Arreola-Risa C. Human resources for the control of road traffic injury. Bull World Health Organ 2005; 83 (04) 294-300
  • 17 WHO. Global status report on road safety. 2018
  • 18 Wesson HK, Boikhutso N, Bachani AM, Hofman KJ, Hyder AA. The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence. Health Policy Plan 2014; 29 (06) 795-808
  • 19 Borowy I. Road traffic injuries: social change and development. Med Hist 2013; 57 (01) 108-138
  • 20 Petroze RT, Byiringiro JC, Ntakiyiruta G. et al. Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting?. World J Surg 2015; 39 (04) 926-933
  • 21 Jayaraman S, Mabweijano JR, Lipnick MS. et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg 2009; 33 (12) 2512-2521
  • 22 Tiska MA, Adu-Ampofo M, Boakye G, Tuuli L, Mock CN. A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J 2004; 21 (02) 237-239
  • 23 Geduld H, Wallis L. Taxi driver training in Madagascar: the first step in developing a functioning prehospital emergency care system. Emerg Med J 2011; 28 (09) 794-796
  • 24 Kesinger MR, Puyana JC, Rubiano AM. Improving trauma care in low- and middle-income countries by implementing a standardized trauma protocol. World J Surg 2014; 38 (08) 1869-1874
  • 25 Ali J, Adam R, Butler AK. et al. Trauma outcome improves following the Advanced Trauma Life Support program in a developing country. J Trauma 1993; 34 (06) 890-898 , discussion 898–899
  • 26 Mock C, Kobusingye O, Joshipura M, Nguyen S, Arreola-Risa C. Strengthening trauma and critical care globally. Curr Opin Crit Care 2005; 11 (06) 568-575
  • 27 Mock CN, nii-Amon-Kotei D, Maier RV. Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 1997; 42 (03) 504-511 , discussion 511–513
  • 28 Mohammed Z, Arafa A, Saleh Y. et al. Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study. Int J Emerg Med 2020; 13 (01) 19
  • 29 Kurdin A, Caines A, Boone D, Furey A. TEAM: a low-cost alternative to ATLS for providing trauma care teaching in Haiti. J Surg Educ 2018; 75 (02) 377-382
  • 30 Tortella BJ, Swan KG, Donahoo JS. et al. Trauma life support education: a didactic and caprine laboratory course for Nigerian physicians. Injury 1996; 27 (05) 329-331
  • 31 Mock CN, Quansah R, Addae-Mensah L, Donkor P. The development of continuing education for trauma care in an African nation. Injury 2005; 36 (06) 725-732
  • 32 Walker IA, Wilson IH. Anaesthesia in developing countries–a risk for patients. Lancet 2008; 371 (9617): 968-969
  • 33 Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S. Surgery in Malawi - a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl 2007; 89 (07) 722-724
  • 34 Vaz F, Bergström S, Vaz MdaL, Langa J, Bugalho A. Training medical assistants for surgery. Bull World Health Organ 1999; 77 (08) 688-691
  • 35 Ngoya PS, Muhogora WE, Pitcher RD. Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country. Pan Afr Med J 2016; 25: 99
  • 36 Laytin AD, Dicker RA, Gerdin M. et al. Comparing traditional and novel injury scoring systems in a US level-I trauma center: an opportunity for improved injury surveillance in low- and middle-income countries. J Surg Res 2017; 215: 60-66
  • 37 Weeks SR, Juillard CJ, Monono ME. et al. Is the Kampala trauma score an effective predictor of mortality in low-resource settings? A comparison of multiple trauma severity scores. World J Surg 2014; 38 (08) 1905-1911
  • 38 Stewart BT, Quansah R, Gyedu A, Ankomah J, Donkor P, Mock C. Strategic assessment of trauma care capacity in Ghana. World J Surg 2015; 39 (10) 2428-2440
  • 39 Hadler RA, Chawla S, Stewart BT, McCunn MC, Kushner AL. Anesthesia care capacity at health facilities in 22 low- and middle-income countries. World J Surg 2016; 40 (05) 1025-1033
  • 40 Ashengo T, Skeels A, Hurwitz EJH, Thuo E, Sanghvi H. Bridging the human resource gap in surgical and anesthesia care in low-resource countries: a review of the task sharing literature. Hum Resour Health 2017; 15 (01) 77
  • 41 Zargaran E, Schuurman N, Nicol AJ. et al. The electronic Trauma Health Record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings. J Am Coll Surg 2014; 218 (01) 41-50
  • 42 Houtchens BA, Clemmer TP, Holloway HC. et al. Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge. Prehosp Disaster Med 1993; 8 (01) 57-66
  • 43 Mock C, Joshipura M, Arreola-Risa C, Quansah R. An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 2012; 36 (05) 959-963
  • 44 WHO. Guidelines for essential trauma care. 2004
  • 45 Peter NA, Pandit H, Le G, Nduhiu M, Moro E, Lavy C. Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model. Injury 2016; 47 (05) 1128-1134
  • 46 St-Louis E, Paradis T, Landry T, Poenaru D. Factors contributing to successful trauma registry implementation in low- and middle-income countries: a systematic review. Injury 2018; 49 (12) 2100-2110
  • 47 Moore L, Clark DE. The value of trauma registries. Injury 2008; 39 (06) 686-695