Bachani Abdulgafoor M, Botchey Isaac, Paruk Fatima, Wako Daniel, Saidi Hassan, Aliwa Bethuel, Kibias Simon, Hyder Adnan A
Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Surgery. 2017 Dec;162(6S):S32-S44. doi: 10.1016/j.surg.2017.05.020. Epub 2017 Oct 16.
Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care.
We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care.
In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation.
There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the injured patient in low- or middle-income countries.
低收入和中等收入国家的伤害发生率位居世界前列，超过90%的意外伤害发生在低收入或中等收入国家。低收入和中等收入国家因伤害导致的死亡风险是高收入国家的6倍。伤害发生率上升的部分原因是受伤者缺乏及时、适当的医疗护理服务。与大多数低收入和中等收入国家一样，肯尼亚在过去40年中伤害死亡人数增加了5倍，这在很大程度上与缺乏协调、综合的创伤护理系统有关。
我们旨在评估肯尼亚的创伤护理系统，并制定和实施一项改进计划。进行了创伤系统概况分析，以了解肯尼亚受伤患者的护理情况。这一过程有助于确定从院前护理到医院护理各环节护理方面的关键差距。
针对这一情况，与当地利益相关者密切合作，制定并实施了一项9点计划，以改善肯尼亚的创伤护理。该9点计划的核心是利益相关者的参与、生成关键数据以指导和改善服务、院前和医院护理的能力建设，以及加强政策和立法。
迫切需要采取协调战略，为低收入或中等收入国家的受伤者提供适当、及时的医疗护理，以减轻伤害及相关死亡的负担。我们在肯尼亚的工作表明，通过逐步综合、多方面的方法可以实现这样一个综合创伤护理系统，该方法强调当地利益相关者的参与和基于证据的方法，以确保全系统改进的有效性、效率和可持续性。该计划及其制定和实施过程中吸取的经验教训可适用于其他类似环境，以改善低收入或中等收入国家受伤患者的护理。
