Understanding Perceptions of Healthcare Professionals on Delays in Care for Traumatic Brain Injury Patients at Mulago National Referral Hospital, Kampala, Uganda

Background: Uganda is experiencing a high rate of Traumatic Brain Injuries (TBI), approximately 170 per 100,000 when compared to the global rate of 106 per 100,000. This may be due to an increasing rate of road traffic incidents (RTIs) and falls. LMICs like Uganda are disproportionately burdened with a higher number of RTI and other risk factors for TBI. One of the foremost reasons for poor outcomes for moderate and severe TBI patients are the delays in seeking, reaching, and receiving care. The aim of this study is to understand the perceptions of pre-hospital and in-hospital delays in seeking, reaching, and receiving care for patients diagnosed with TBI at Mulago National Referral Hospital (MNRH), and obtain perceptions of interventions that could reduce delay for these patients.

Methods: The study is a qualitative research project and will be carried out at Mulago National Referral Hospital, Kampala district, Uganda. The study participants were healthcare professionals in the Neurological ward of this hospital. This study will utilize semi-structured in-depth qualitative interviews, outlined through “The Three Delay Framework”, to understand perceptions of the reasons behind the three delays: seeking, reaching, and receiving care. Additionally, collecting perspectives on what can be done about the delays.

Results: During the study period, fourteen healthcare professionals in the Neurological ward of MNRH were interviewed. Of the fourteen, three were senior neurosurgeons, six were neurosurgical residents, and five were nurses. Four themes were derived from the data, Transportation, Knowledge and Stigma, Surgical Intervention Preparedness, and Financial Burdens. Nineteen sub-themes or sub-codes were found during analysis and were deductively pre-coded for either delay or solution. Transportation Means, Physical Distance, Road Conditions, Injury Knowledge, Hospital Knowledge, Hospital Stigma, Communicable Disease Information, Instruments, Resources, Staff, Space, Equipment, Investigations, Cost of Obtaining care, Cost of Transport, Cost of Cheaper Care, Cost of Investigations, Cost of Surgical Equipment, and Cost of Medication are all found within the four main themes.

Conclusions: Understanding perceptions of delay and methods to reduce them from the prospective of the healthcare professional established confirmation of current issues affecting care at MNRH. The data also demonstrated the issue of understanding the delays but not methods to solve them. Interviews with patients and their families are the next step in understanding these prevalent issues and creating an appropriate intervention to reduce them.