Institute of Applied Health Research, University of Birmingham, Birmingham, UK
School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
BMJ Open. 2024 Apr 29;14(4):e081652. doi: 10.1136/bmjopen-2023-081652.
To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care.
Retrospective analysis of existing VA data routinely collected by a demographic surveillance site.
Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi.
Fatally injured members of the HDSS.
The primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system.
Of the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11-48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, 'healthcare literacy' was most commonly implicated barrier in 75% (15/20). Within Delay 2, 'communication' and 'prehospital care' were the most commonly implicated in 92.5% (37/40). Within Delay 3, 'physical resources' were most commonly implicated, 85.7% (42/49).
VA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system.
利用死因推断（VA）数据了解与致命伤害相关的卫生系统利用情况和潜在可避免性。然后，根据考虑寻求（延迟 1）、到达（延迟 2）或接受（延迟 3）高质量创伤护理的延迟的三延迟框架，对任何明显的可避免护理延迟的驱动因素进行分类。
对人口监测点常规收集的现有 VA 数据进行回顾性分析。
马拉维北部卡拉翁健康和人口监测站点（HDSS）人群。
HDSS 中致命受伤的成员。
主要结果是潜在可避免的致命伤害死亡比例。次要结果是与可避免死亡相关的延迟阶段和相应的障碍，以及卫生系统内致命伤害的卫生系统利用情况。
在 252 例因外部原因导致的死亡中，分析了 185 例与伤害相关的死亡。死亡主要发生在年轻男性中（中位数年龄 30 岁，IQR 11-48），占 71.9%（133/185）。35.1%（65/185）被评估为潜在可避免的。在 30.8%（20/65）的潜在可避免死亡中涉及延迟 1，在 61.5%（40/65）中涉及延迟 2，在 75.4%（49/65）中涉及延迟 3。在延迟 1 中，“医疗保健素养”是最常见的75%（15/20）的相关障碍。在延迟 2 中，“沟通”和“院前护理”是最常见的 92.5%（37/40）。在延迟 3 中，“物理资源”最常见，占 85.7%（42/49）。
VA 可用于研究创伤后可避免死亡的护理途径和卫生系统反应性，并确定导致死亡的延迟。很大一部分伤害死亡是可以避免的，我们已经确定了几个潜在的干预目标。完善和整合 VA 与其他卫生系统评估方法可能是全面了解创伤护理卫生系统所必需的。
