Browsing by Author "Staton, Catherine Lynch"

Traumatic brain injury (TBI) is the most common cause of death and disability globally. TBI is a leading cause of resource consumption and disproportionately affects LMICs. Innovative solutions are required to address this high burden of TBI. Prognostic models could provide a solution since the models enhance diagnostic ability of physicians, thereby helping to tailor treatments more effectively. This study aims to evaluate the feasibility of a prognostic model developed in Tanzania for TBI patients amongst Kilimanjaro Christian Medical Center (KCMC) healthcare providers and Duke affiliated healthcare providers. Duke health system participants were included primarily to gain insight from a different context with more established practices to inform the TBI tool implementation strategy at KCMC. To evaluate the feasibility of integrating the TBI tool into potential workflows co-design interviews were conducted with emergency physicians and nursing staff. Qualitatively, the tool was assessed using human centered design (HCD) techniques. Our research design methods were created using the Consolidated Framework for Implementation Research which considers overarching characteristics of successful implementation to contribute to theory development and verification of implementation strategies across multiple contexts. Findings of this study will aid in determining under what conditions a TBI prognostic model intervention will work at KCMC and the potential use of HCD in implementation research.

Background: Harmful alcohol use and violence are both major contributors to global mortality and morbidity rates, despite being both predictable and preventable. This study seeks to quantitatively determine the scope of violence-related injury and Alcohol Use Disorders in a referral hospital in Moshi, and qualitatively determine 1) how violence-related injury patients perceive alcohol use influences the occurrence of violence and 2) how experiencing a violence-related injury influences patients’ subsequent alcohol use behavior.

Methods: This study was conducted at Kilimanjaro Christian Medical Center (KCMC). Survey data was obtained from a trauma registry including all injury patients ≥ 18 years admitted to the emergency room. Interview participants were included if they reported their injury was due to violence, tested positive for alcohol (by breathalyzer) upon admittance, medically stable, able to communicate and provide informed consent in Swahili or English, and clinically sober at the time of enrollment.

Results: From the 500 injury patients enrolled in the trauma registry from April 17, 2018 to January 12, 2019, 84 (16.8%) reported that their injury was due to violence. Patients with violent injuries were 2.21 times more likely to have a positive alcohol status compared to non-violent injuries (95% CI 1.36, 3.60, p<0.01). Among violent injuries, those with a positive alcohol status were 6.26 times more likely to have an Alcohol Use Disorder compared to those with a negative alcohol status (95% CI 2.13, 18.39, p<0.001). Interview respondents reported a perception that violent injuries were worse from other injuries, that the perpetrator was also under the influence of alcohol, that alcohol contributes to violence, and a desire to change alcohol use behavior following their injury.

Conclusion: Alcohol use and violence-related injury pose a significant threat to health and well-being globally. In Moshi, Tanzania, both issues are prevalent and contribute to a sufficient disease burden. This study has added to the data on alcohol-attributable harm, contributing to expanding information available on this issue from LMICs. To adequately reduce violence-related injuries in this setting, it is necessary to address harmful alcohol use as well.

Background: The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and people around them. This study sought to provide a better understanding of how risky behaviors are associated with alcohol use perceptions. Methods: This mixed method study took place in the Kilimanjaro Christian Medical Center. Quantitative data on alcohol use, the alcohol use disorder identification tool, alcohol-related consequences, and qualitative data on alcohol use perception and risky behaviors were collected from a hospital- and non-hospital-based sample in Moshi, Tanzania. Latent class analysis was applied to examine alcohol-related risky behaviors. Results: Three classes of risky behavior patterns were identified: “no risky behavior”, “moderate risky behaviors” and “high risky behaviors”. Membership of classes 3 was associated with the most alcohol use quantity and frequency. No association between classes and alcohol-stigma was found. Our qualitative results explored alcohol perceptions and risky behaviors and illustrated their possible associations. Conclusions: Although alcohol stigma may not associate the number of risky behaviors directly, our qualitative result helped us to understand how stigma associates with risky behaviors. This study may serve as a reference for designing and adjusting interventions for alcohol-related injury patients' needs; we can improve interventions by using our knowledge about misconception and stigma and the identified risky behaviors classes as a form of classification system.

Background: Globally, road traffic injury (RTI) is predicted to become the fifth leading cause of mortality by 2030. In addition to the burden of RTI, multimorbidity (MM) is increasingly becoming a health concern across all age groups. If MM is left unaddressed, individuals suffering from RTI will most likely experience delayed recovery and poorer health outcomes. Thus, there is a need to examines the association between RTI and MM in order to inform post-injury care practices.

Methods: This study is a cross-sectional analysis of the 2013 Brazilian National Health Survey. 60,202 individuals, aged 18 and above, were included in this study. Univariate and bivariate analyses were used to explore the relationship between demographic variables, chronic diseases, MM and RTI. Network analysis was used to identify multimorbidity patterns.

Results: Out of those who had experienced RTI (n=1910), 16.50% have reported having a multimorbid condition. Age, gender, risky alcohol use and regions were key predictors of RTI. Risky alcohol use was one of the direct nodes that connected RTI to other morbidities. Within the road traffic injured population, seven multimorbid communities were identified, with two communities being the most central: the cardio-metabolic morbidities and physical-mental morbidities.

Conclusions: Risky use of alcohol was a key predictor of RTI and a potential mediator in the association between RTI and other morbidities. Given that the temporal association between RTI and MM could not be established in this study, additional studies are needed to further assess the direction of the association between RTI and MM.

Background: Alcohol consumption is a major risk factor for several adverse health effects globally and is associated with a high disease burden of malnutrition in Tanzania. This study aims to: 1) assess the practicality and effectiveness of mid-upper arm circumference (MUAC) as a feasible bedside measure to detect malnutrition among adult and pediatric patients, 2) evaluate the association between alcohol use and nutritional status among adult injury patients and 3) qualitatively identify social determinants of malnutrition in Tanzania. Methods: This mixed-method study was conducted in Kilimanjaro Christian Medical Centre. Receiver Operating Characteristic (ROC) curves and logistic regression were used for quantitative data on alcohol use, body mass index (BMI), MUAC. Thematic approach was used for qualitative data on perspectives on alcohol use and its interactions with malnutrition. Results: MUAC cut-offs were determined at < 25.5 cm (BMI < 16 kg/m2) for severely underweight, < 28 cm (BMI < 18.5 kg/m2) for underweight, ≥ 30.5 cm (BMI ≥ 25 kg/m2) for overweight, ≥ 33 cm (BMI ≥ 30 kg/m2) for obese. The association between alcohol use and malnutrition (MUAC < 25.5 cm) was statistically significant. Qualitative results helped explain the association between alcohol use and malnutrition. Conclusions: MUAC is an effective tool to detect adult malnutrition to inform clinical practice in Tanzania. Polarizing attitudes towards drinking revealed by qualitative data suggested the need for alcohol awareness campaigns. Food assistance programs are needed to reduce the risk of malnutrition among vulnerable populations.

Background: Trauma and injury present a significant global burden – one that is only exacerbated in low- and middle-income settings like Tanzania. We aimed to describe the landscape of emergency care and financial catastrophe in the Kilimanjaro region by leveraging the Three Delays Model.

Methods: This was a cross-sectional study using an ongoing traumatic injury registry as well as separate financial questionnaires collected by researchers from the Duke Global Health Institute at Duke University in collaboration with the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from December 2022 until February 2023.

Results: The majority of the acute injury population that presented to the KCMC emergency department underwent some form of financial catastrophe due to the out-of-pocket (OOP) costs incurred due to their medical needs (catastrophic health expenditure (CHE): 66.1%; impoverishment: 85.5%). The households of those who experienced a financial catastrophe tended to include a greater number of dependents (CHE, 22% and impoverishment, 21% with ≥6 dependents) and a lower average monthly adult-equivalent income (CHE: 76,923 TZS; impoverishment: 96,774 TZS). Individuals who underwent a financial catastrophe also experienced a greater number of facility transfers as well as more transfers with later surgery. At the end of an individual’s hospital stay, those who experienced financial catastrophe incurred substantially more medical expenses. Those who experienced a CHE had OOP costs that were 3.4 times higher than those without; those who were impoverished had OOP costs that were 1.96 times higher than those who did not.

Conclusions: Delay 1 (decision to seek care) and Delay 2 (reaching appropriate care facility) could be significant factors for those who will later experience some form of financial catastrophe. Further research is needed to better assess potential impacts on patient health outcomes and develop targeted intervention strategies for those most at-risk.

Background: Injury currently accounts for 6% of all disability adjusted life years (DALYS) lost. As the global incidence of injuries increases, so does the need for care. Current research on access to care and injury does not always account for injury severity or focus on the overall effects of injury. Our project focused on a medium-sized city in Brazil to determine what barriers to care after injury arise in Brazil’s universal health care system.

Methods: Households were randomly selected for survey in the 561 populated districts of the city of Maringa between May 2015 and September 2015. Demographic information was collected for the entire household; one individual from the household was then randomly selected to provide injury history. A chi-square analysis was used to determine the association between care seeking and demographics. A preliminary significance level of α = 0.20 was selected for inclusion of variables into the multivariate logistic regression. A full multivariate logistic regression model using injury as the primary exposure and seeking care as the outcome was run. Thirty reduced models were run; mean squared estimate (MSE) and Akaike Information Criterion (AIC) were calculated to find the best predictive model.

Results: 2678 households and individuals participated, 30.3% individuals reported an injury in their lifetime. The bivariate analysis found that gender (p = 0.034), cause of injury (p = 0.000), race (p = 0.051), severity (p = 0.103) and insurance status (p = 0.026) were potential predictors of seeking care. Education (p = 0.62), income (p = 0.343) and age (p = 0.838) were included in the multivariate model due to past significance in the literature. The reduced multivariate model that eliminated education level and race (MSE = 0.0274, AIC = 0.7689) was chosen as the best representative model and showed gender, age, socioeconomic status, and cause of injury as all strong predictors of care seeking.

Conclusions: Cause of injury is a major predictor for seeking care, as are factors related to socioeconomic status such as insurance and income. Injury cause potentially masked the effects of gender on care seeking. More research needs to be done on specific causes of injuries, the role of gender, and why socioeconomic status is still a barrier to care in a universal access system.

Background: Traumatic brain injury (TBI) has a disproportionate burden on low- and middle-income countries (LMICs) and cost-effective and culturally relevant measures are necessary to improve TBI care. This study aims to characterize emergency healthcare providers’ decision making when treating TBI patients, develop a machine learning-based model to predict TBI patient outcome, and conduct a decision curve analysis (DCA) to evaluate model clinical applicability. Methods: This study is twofold: 1) a secondary analysis of a TBI data registry with 4142 patients and 2) a survey examining physicians decision-making in treating 50 TBI patients in real time. Results: Five machine learning models were developed with AUCs ranging from 70.86% (Single C5.0 Ruleset) to 85.67% (Ensemble Model). DCA showed that all models exhibited a greater net benefit over ranges of clinical thresholds. The survey collected information on 50 patients providing insight on tools used by physicians in real-time when treating TBI patients as well as the unmet need patients at KCMC faced. Conclusions: This study is the first to use machine learning modeling and DCA in the context of TBI prognosis in Sub-Saharan Africa. Prognostic models have great potential within the decision-making process for treating TBI patients in LMIC health systems and such utility can be expanded through determining different threshold probabilities for various interventions.

Background: Acutely painful conditions, responsible for a large proportion of Emergency Department patients around the world, are inadequately assessed and poorly treated. Routine use of scales to quantify pain is recommended to improve analgesic practice. Currently, no such scale has been validated for use in Kiswahili-speaking patients in Tanzania. The objective of this study was to develop and assess a culturally relevant pain intensity scale for use in injury patients at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. Methods: This was a two-part study, with the initial phase using focus groups to develop a pain scale. The second phase used a convenience sample of injury patients to assess the scale for validity and reliability. Analysis of variance, intra-class correlation coefficients, and Bland-Altman Analysis were used to assess validity and reliability. We used focus groups and surveys to develop a pain scale, which was subsequently tested in injury patients. Results: A 100-point numeric pain scale was developed and tested among 98 injury patients. The intra-class correlation coefficient of scores was 0.97 (95% CI 0.96 - 0.98) and Bland-Altman analysis found that 95% of the differences were between -23.5 and +20.7. Conclusions: Our results suggest that a 100-point numeric rating scale is valid and reliable for use Tanzanian injury patients.

Background: Intimate partner violence is a global burden that disproportionately affects women and has more severe outcomes in women as well. Our objective was to explore the epidemiologic profile for intimate partner violence and preliminary patterns in the underreporting of this burden in Maringá, Brazil. Methods: A community-based cross-sectional study was conducted in Maringá. A convenience sampling method was utilized to recruit participants. 435 women at least 18 years of age who either currently had or had previously had an intimate partner were interviewed about their experiences with IPV. Sociodemographic characteristics were collected at the time of the interview to estimate associations with IPV using univariable and multivariable logistic regression models. Positive IPV cases identified from the community survey were compared with positive IPV cases identified from the Maringá city violence registry using sociodemographic variables and location variables in both datasets to explore patterns of underreporting. Results: Lifetime prevalence of IPV was 53.79%. Significant bivariate associations found between the SES indicator occupation and psychological violence (X2 = 8.688, p < 0.05) and overall IPV (X2 =12.441, p < 0.01) showed differences in distribution of IPV among the different levels of occupation. Significant bivariate associations found between the SES indicator number of children and physical violence (X2 = 6.963, p < 0.05) and sexual violence (X2 = 8.969, p < 0.05) also showed differences in distribution of IPV among the different levels of number of children. Women who had no paid work outside the home seemed to experience all 3 types of violence as well as overall IPV significantly less than women who had paid work outside the home (p < 0.05). Having 4 or more children was noted to significantly increase women's experience with physical and sexual violence (p< 0.01). Patterns of underreporting noted were associated with older age, women racially self-identifying as brown, and women being either illiterate, or completing higher education. Geospatially, IPV cases found through the community survey were ill-represented in the violence registry. Conclusion: IPV is a significant burden in Maringá and some underreporting patterns were noted through this study. These findings highlight the need for further research into conditional and precipitation risk factors of IPV and further exploring the burden and reasons for underreporting of IPV. Care settings can be potential sites for screening communities for IPV and exploring patterns in reporting of IPV.

BACKGROUND: This study describes the prehospital transport of traumatic brain injury (TBI) patients and its impact on TBI outcome to inform quality improvement for the existing trauma system. Data was collected over 4 months at a major referral hospital in Moshi,Tanzania.

METHODS: Patient demographics, mechanism of injury, injury severity (Glasgow Coma Score), and vitals were recorded on presentation to the Casualty Department. Prehospital factors recorded include time, distance and cost. Multivariable regression analyses evaluated the effect of prehospital factors on unfavourable patient TBI outcome, in-hospital factors and demographics were controlled for. Unfavorable outcome was defined as Glasgow Outcome Score<5 on discharge or death.

RESULTS: Road traffic injuries were the most common mechanism of injury (67.1%). The majority of patients were referred from other facilities in and around the region (62.3%), with 23% from the local public hospital There was no evidence of prehospital care available in this region. Average prehospital duration was more than 1 hour, a third of this was spent in prehospital transit for a majority of the patients. A minority used Ambulances. Predictors of unfavourable outcome (GOS<5) were: prehospital time greater than 60 minutes, multiple physical transfers during the prehospital course and being referred from another hospital.

CONCLUSION: The lack of prehospital care calls for further research into prehospital interventions for this setting. Further analysis should be conducted with a larger sample size to increase accuracy of the findings.

Background: Globally, traumatic brain injury (TBI) accounts for the highest burden of deaths and disabilities globally. Studies suggest a complex relationship between injury, mental health, and alcohol. Though hazardous alcohol use and TBI exert heavy burdens in Tanzania, their interaction with mental health is largely unknown. This study aims to explore the mental health and alcohol use profiles of TBI patients in a low-income country.

Methods: Secondary data analysis of a registry of adults (≥ 18) with TBI of any severity presenting to the Kilimanjaro Christian Medical Center Emergency Department (ED) within 24 hours of injury. Patient data were collected at ED arrival and at three months follow-up. Variables included measures of functional independence, psychiatric health, quality of life, and alcohol use. Hazardous alcohol use was defined as an Alcohol Use Disorder Identification Test (AUDIT) score greater than seven. We conducted a latent profile analysis (LPA) to determine pre-injury mental health profiles of patients and logistic regression to assess association of patient profile with hazardous drinking at three months after injury.

Results: Of 190 participants, 51 (26.8%) were hazardous drinkers. The majority of the sample was male (83.7%) and the median age was 29.5 years. The LPA model with the strongest fitness revealed five profiles of mental health and drinking patterns. The “Poor Mental Health Drinkers” (9.4%) profile had worse quality of life and higher depression and hazardous drinking scores. The “Disabled Non-drinkers” (11.4%) profile had worse motor functional independence and low hazardous drinking scores. The “Non-drinkers” (53.5%) had good quality of life, little to no depression, good functional independence and low hazardous drinking scores. The “Drinkers” were similar to the “Non-drinkers” profile, except with high hazardous drinking scores. Predictors of hazardous drinking three months post-injury included disability and being a hazardous drinker before injury.

Conclusions: This study provides insight into the possible mental health and drinking pattern profiles for TBI patients. The categorization of patients may help in resource allocation of alcohol interventions for those who are at the highest risk for hazardous alcohol use. Limitations included recall bias for pre-injury information.

Background: The rise in the prevalence of musculoskeletal disorders (MSDs) places a high burden on healthcare services, especially in the emergency departments (EDs) of hospitals in Western and European countries. MSD-related complaints are one of the most common complaints in such EDs where 10-40% of cases are non-urgent and could be treated in a primary health care center (PHCC) instead. Findings on factors driving patients to attend the ED instead of a PHCC are known to vary in different parts of the world ranging from socio-economical factors to cultural preference; however, most studies have been based primarily on western, industrialized countries and findings are not generalizable to rapidly developing countries which exhibit the same phenomenon such as Qatar. This study aims to extend prior research and examine factors driving patients with non-urgent MSDs to attend the ED in the demographically diverse country of Qatar. Study design: Purposive sampling was used to recruit patients with musculoskeletal complaints age 18 years and older in the "See `N Treat" and "Male Fast Track" areas at the ED of Hamad General Hospital (HGH). Patients with non-urgent MSDs were interviewed about main reasons for attending the HGH ED instead of a PHCC. An applied thematic approach was used to analyze data to determine themes and trends among patient responses. Results: 97 patients were interviewed; 70% were men and 30% were women. 70% of patients interviewed were non-Qatari. The median age of all patients was 35.5 years old (IQR, 27-44.2). The main reasons given for attending an ED were: seeking immediate relief from feeling severe pain (63%), perceived severity of the condition as an emergency and believing ED use is appropriate (29%), and referral from other health facilities (9%). The main reasons for attending the ED of HGH particularly were: preference/convenience (49%), access (15%), lack of knowledge (15%), and influence by employer (15%). Conclusion: The majority of patients preferred attending the ED of HGH for the higher quality of services in comparison to other local PHCCs. Low quality MSD management in PHCCs for patients who experience recurrent pain is often a driving factor as well where it was more feasible for them to access services at the ED of HGH instead of a PHCC. A significant portion of non-Qatari patients attended the ED due to lack of knowledge of other services and misadvise from their employers. Such external factors leading to increased burden on the ED of HGH could be addressed by increasing access to alternative centers. Mandating employers to inform employees of the existence of PHCCs and provide them with health services could also reduce the burden of non-urgent ED use. Enforcement of established protocols and strategies on MSD management could also improve the quality of service in PHCCs and contribute to MSD prevention, thus lowering the burden on the healthcare system.

Background: Self Determination Theory (SDT) conceptualizes human motivation in terms of a spectrum. However, literature is scarce on how to measure self-determination in different languages or how self-determination can influence the effectiveness of healthcare interventions. The aim of this study was to translate and culturally adapt a psychometric questionnaire on self-determination (TSRQ) as well as SMS booster messages for a Brief Intervention (BI) aimed at reducing harmful alcohol use among injury patients presenting at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.

Methods: A mixed-methods approach was used to evaluate the psychometric properties of the TSRQ and SMS booster messages. Likert-scale surveys were administered on expert panels to assess translation quality and adherence to theory.

Results: Quantitative analyses confirmed that the Swahili translation of the TSRQ accurately reflected SDT constructs. Exploratory Factor Analysis (EFA) revealed a two-domain model had a better fit than the original three-domain TSRQ. Expert panel surveys indicated that the SMS booster messages maintained strong connections to tenets of SDT.

Conclusion: This was the first study to conduct a cross-cultural validation of the TSRQ in Tanzania and the first to implement and assess motivational constructs in SMS booster messages for a BI to promote safe alcohol use. The TSRQ is a valid, clinically useful scale but could be improved with more items. SMS booster messages touch on many SDT constructs, affirming their motivational utility.

Background: Sri Lanka is experiencing an epidemic of road traffic crashes and injuries but little is known about the burden among adolescents and associated risk factors. The objective of this paper is to assess the prevalence of road traffic crashes and injuries among adolescents aged 16-18 years old and to estimate the effect of risk factors, including demographic characteristics, behaviors and built environment characteristics around school, on the occurrence of both crashes and near misses. Methods: First, A survey was anonymously administered to determine demographics, behavior, and experience of road traffic crashes and related injuries among adolescents from 16 public high schools in Galle, Sri Lanka. Second, a built environment observation was also conducted near school surroundings. Descriptive analysis and multivariate regression analysis was conducted to assess the relationship between built environment and road traffic crashes/near misses by using STATA. The results were displayed in the map by using ArcGIS. Results: Among 1307 students from 16 public high schools aged between 16-18 years old, 206 students self-reported road traffic crash involvement in the past 6 months with 98 students reporting minor injury and 7 students suffering severe injury. In addition, 27.8% of respondents were involved in near misses in the past 6 months. Male students, who demonstrated poor road behaviors, and students who experienced near misses are more likely to be involved in road traffic crashes. Additionally, more than half of the roads around these schools are in poor condition with little infrastructures to separate pedestrians and cyclists from vehicles. The occurrence of road traffic crashes and the severity of road traffic injuries are significantly related to some environmental characteristics, which tend to include road type and road visibility. Conclusions: Adolescents in Galle, Sri Lanka are facing a comparatively high burden of road traffic crashes. Conducting intervention programs among male students and improving built environment on the way to school are potential effective strategies to prevent adolescents from road traffic crashes and injuries.

Alcohol is a leading risk factor for injury. Road traffic injuries are a leading killer, but perceptions of drinking and drink driving in Tanzania are unclear. This research aims to define how perceptions of drinking influence risky driving behavior at Kilimanjaro Christian Medical Center in Moshi, Tanzania. This mixed methods study incorporated the Alcohol Adapted Perceived Discrimination-Devaluation scale (PDD) and the Alcohol Use Disorders Identification Test (AUDIT) among 96 injury patients regardless of their alcohol use prior to injury. Results were reported as medians and IQRs with Kurskal Wallis tests. Additionally, focus groups with injury patients, their families, and community members (n = 63) were conducted and analyzed in parallel using an inductive thematic content analysis approach. Of the 96 injury patients surveyed, 53 used alcohol and 17%(n=9) of those self-reported driving after ingesting 3 or more alcoholic drinks (SRDD). SRDD’s average AUDIT score (median=11) was significantly different from those who denied drink driving (median=6, p= 0.03). The PDD showed a high overall stigma, particularly discrimination, against those who use alcohol; but, the PDD was similar for drinkers and abstainers from alcohol (median=2.7 and 3.1, respectively). Thematic content analysis highlighted an ‘inability to change those that drink drive, ‘disapproving of drink driving’, and a ‘necessary police enforcement on drink driving.’ While stigma is present in Tanzania against those who use alcohol, it does not impact the choice to drink and drive, and was not stronger in drinkers or abstainers. Overall, there appears to be a community-wide disapproval of drinking and driving coupled with feeling unable to change this risky behavior.

Background: Injuries account for about 13% of all registered deaths in Sri Lanka, and are the leading cause of admission to public hospitals. Each year, about 62,377 people with injuries require inpatient care in the Galle district. The prehospital trauma care system is new to Sri Lanka and a free ambulance service was launched about two years ago, with most ambulances concentrated in the larger cities around major hospitals.

Objective: The objective of this study was to describe the prehospital transportation and care of people with externally-caused, acute injuries and examine factors associated with ambulance transport the first health facility.

Methods: A cross-sectional survey, with a small longitudinal component was administered to 405 patients that were admitted the emergency trauma center at Teaching Hospital Karapitiya in Galle, Sri Lanka. Information on patients’ medical treatment and length of stay were extracted from the medical records. Descriptive statistics were tabulated to summarize prehospital transportation and care variables. Logistic regression was used to examine predictors of ambulance transport, and negative binomial regression was used to examine transport time, mode of transport, and prior medical care as effect modifiers of injury event and length of stay relationship.

Results: Over 50% of people used a tuk-tuk to get to the first health facility, and 20.5% used an ambulance to get to the first health facility. Factors that were significantly associated with ambulance use were age, injury mechanism, alcohol, location type, open wound, abrasion, and chest/abdomen injury. Ambulance transport and prior medical treatment were significant effect modifiers for open wound and fractures.

Conclusion: Ambulance transport and prior medical treatment of fractures and open wounds were associated with a reduced length of stay which could help alleviate the burden on already constrained resources at tertiary care facilities.

Background: A growing number of female passengers of a newly-introduced battery powered taxi, referred to as the `Easy Bike´, sustained Spinal Cord Injuries and anterior neck lacerations. This severe injury occurs, as their traditional scarves entangle in the taxi´s engine drive shaft. Injuries sustained by entanglements of scarves in machinery has been known in the literature as Scarf Injuries. This study aimed to conduct key informant interviews to explore Scarf injury survivors challenges in receiving adequate care and maintaining a high Quality of Life (QoL). Methods: We conducted semi-structured in-depth interviews with 12 Scarf Injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. Results: The main themes that emerged from the qualitative data were 1) perceived level of health, function and possible participation, 2) access to emergency and acute care and quality of care, 3) challenges in community reintegration. Participants often perceived their ability to perform activities and tasks to be lower than their bodily functions allowed, leading to a self-limitation in their daily social life. Commonly reported health concerns were urinary and bladder control, infections and breathlessness. None of the participants perceived that they received appropriate emergency care at the injury site, and transportation to a medical facility usually occurred in unsafe vehicles due to limitations in general awareness and knowledge of the injury sustained. At the facilities there was a reported gap in knowledge and competencies regarding the etiology of this type of SCI, leading to multiple referrals for diagnosis and delayed management. Community and social reintegration was mainly impacted by lack of financial resources, lack of realistic goals, poor mental health including suicidal thoughts and previously mentioned secondary complications.

Conclusions: Increasing awareness and knowledge about SCI emergency and acute care might contribute to improved long-term clinical outcomes and survival rates among Scarf Injury survivors. Moreover, greater competencies and awareness among providers to manage this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would result in earlier adoption of a coping process.

Implications: Early rehabilitation that focuses on physical and mental health, alongside empowerment and integration, appears to be lacking in this setting Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.

Background:

Injury is a leading cause of morbidity and mortality globally, accounting for 11% of global disability-adjusted life years (DALYs) and 6% of global years lived with disability (YDLs). The burden of injury is disproportionately high in low- and middle-income countries (LMICs), including Tanzania. Early and effective pain management for injury patients is essential to ensure proper physical, psychological, and emotional outcomes and recovery, yet few studies have examined emergency department analgesic strategies in Tanzania. This study aimed to analyze the sociodemographic and injury characteristics associated with severe pain of injury patients admitted to the Kilimanjaro Christian Medical Centre (KCMC) emergency department, and qualitatively describe analgesic practices and challenges in the KCMC ED.

Methods:

Self-reported sociodemographic and pain data (score 0-100) data were collected from a prospective trauma registry of adult patients (n=1181) admitted to KCMC ED for acute injury. Injury severity data were determined by the Kampala Trauma Score (KTS). Descriptive statistics were performed and multivariable linear regressions assessed the association between sociodemographic and injury characteristics with severe pain. KCMC ED physicians and nurses (n=11) were recruited to participate in qualitative interviews aimed at understanding common analgesic practices and challenges in the ED setting.

Results:

Mean pain level decreased across all sociodemographic characteristics between ED admittance and ED discharge. Participants who were either separated or widowed were likely to experience higher reduction in pain level during ED treatments than those who reported living with a partner. Participants who were admitted to the KCMC ED for road traffic injury or fall were more likely to experience lower reduction in pan level than participants with assault injuries. Interviewed KCMC ED physicians and nurses described high usage of pharmacological analgesic methods for traumatic injury patients.

Conclusion:

It is important to understand effective analgesic treatments that can be administered as early as possible post-injury. KCMC ED pain management modalities are generally effective at reducing pain of traumatic injury patients. Adjustments to strategies for road traffic accident and fall injury patients may be made so that higher levels of pain reduction are achieved.

Background: Globally, hypertension affects one billion people and disproportionately impacts the developing world. Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness and compliance with treatment. The current model of community-based screening does not always ensure follow-up for treatment initiation. In high-income countries, emergency department (ED)-based screening has been successful at capturing undiagnosed/uncontrolled hypertension cases.

Methods: Between July 2017 and March 2018 we conducted a prospective cohort study of hypertensive patients in the emergency department of Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Adults patients with a triage blood pressure > 140/90 were recruited, completed a demographic and knowledge, attitudes and practices (KAP) survey and were followed for one month. Hypertension was defined as a single blood pressure ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Successful follow-up was defined as seeing a medical doctor within one month of the ED visit. Basic demographics were performed and to investigate relationships with potential risk factors and failure to follow-up, generalized linear models were used.

Results: We enrolled 595 adults (mean age 59.6) including 175 men (39.2%) and 271 women (60.7%). Of the 600 patients enrolled, 590 (99%) meet our definition for hypertension. Overall, the prevalence of hypertension was 10.3 % (95% CI 9.5,11.0) and 303 (56.2%) of participants failed to follow-up with a primary care physician within 1 month of the ED visit. Successful follow-up was independently associated with understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with being worried about a future with hypertension (RR 0.80; 95% CI .64,1.00). The majority (78.6%) of the participants were aware of their disease, but many 223 (37.2%) had uncontrolled hypertension and 265 (44%) had evidence of end-organ damage.

Conclusion: The emergency department in Moshi Tanzania experiences a high burden of hypertensive patients, the majority of which fail to follow-up within one month of the ED visit. Multi-disciplinary strategies should be employed to improve linkage to care for high-risk patients from the emergency department.