Assessing the capacity of Malawi’s district and central hospitals to manage traumatic diaphyseal femoral fractures in adults

English version

Autoři: Kiran J. Agarwal-Harding ^aff001; Linda Chokotho ^aff003; Sven Young ^aff004; Nyengo Mkandawire ^aff003; Mabvuto Chawinga ^aff005; Elena Losina ^aff002; Jeffrey N. Katz ^aff002
Působiště autorů: Harvard Combined Orthopaedic Residency Program, Boston, MA, United States of America ^aff001; The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, United States of America ^aff002; Department of Orthopedics, Queen Elizabeth Central Hospital, Blantyre, Malawi ^aff003; Department of Orthopedics, Haukeland University Hospital, Bergen, Norway ^aff004; Department of Orthopedics, Kamuzu Central Hospital, Lilongwe, Malawi ^aff005; College of Medicine, University of Malawi, Blantyre, Malawi ^aff006; Department of Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi ^aff007; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America ^aff008; Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America ^aff009
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225254

Souhrn

Background

The burden of musculoskeletal trauma is growing worldwide, disproportionately affecting low-income countries like Malawi. However, resources required to manage musculoskeletal trauma remain inadequate. A detailed understanding of the current capacity of Malawian public hospitals to manage musculoskeletal trauma is unknown and necessary for effective trauma system development planning.

Methods

We developed a list of infrastructure, manpower, and material resources used during treatment of adult femoral shaft fractures–a representative injury managed non-operatively and operatively in Malawi. We identified, by consensus of at least 7 out of 10 experts, which items were essential at district and central hospitals. We surveyed orthopaedic providers in person at all 25 district and 4 central hospitals in Malawi on the presence, availability, and reasons for unavailability of essential resources. We validated survey responses by performing simultaneous independent on-site assessments of 25% of the hospitals.

Results

No district or central hospital in Malawi had available all the essential resources to adequately manage femoral fractures. On average, district hospitals had 71% (range 41–90%) of essential resources, with at least 15 of 25 reporting unavailability of inpatient ward nurses, x-ray, external fixators, gauze and bandages, and walking assistive devices. District hospitals offered only non-operative treatment, though 24/25 reported barriers to performing skeletal traction. Central hospitals reported an average of 76% (71–85%) of essential resources, with at least 2 of 4 hospitals reporting unavailability of full blood count, inpatient hospital beds, a procedure room, an operating room, casualty/A&E department clinicians, orthopaedic clinicians, a circulating nurse, inpatient ward nurses, electrocardiograms, x-ray, suture, and walking assistive devices. All four central hospitals reported barriers to performing skeletal traction. Operative treatment of femur fracture with a reliable supply of implants was available at 3/4 hospitals, though 2/3 were dependent entirely on foreign donations.

Conclusion

We identified critical deficiencies in infrastructure, manpower, and essential resources at district and central hospitals in Malawi. Our findings provide evidence-based guidance on how to improve the musculoskeletal trauma system in Malawi, by identifying where and why essential resources were unavailable when needed.

Klíčová slova:

Nurses – Surveys – Inpatients – Traumatic injury – Malawi – Orthopedic surgery – Geological surveys – Musculoskeletal injury

Zdroje

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