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Current Patterns of Prehospital Trauma Care in Kampala, Uganda and the Feasibility of a Lay-First-Responder Training Program

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Abstract

Background

Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program.

Methods

We conducted a cross-sectional survey of current prehospital care providers in Kampala: police officers, minibus taxi drivers, and Local Council officials, and collected data on types and frequencies of emergencies witnessed, barriers to aid provision, history of training, and current availability of first-aid supplies. A context-appropriate course on basic first-aid for trauma was designed and implemented. We measured changes in trainees’ fund of knowledge before and after training.

Results

A total of 309 lay people participated in the study, and during the previous 6 months saw 18 traumatic emergencies each; 39% saw an injury-related death. The most common injury mechanisms were road crashes, assault, and burns. In these cases, 90% of trainees provided some aid, most commonly lifting (82%) or transport (76%). Fifty-two percent of trainees had previous first-aid training, 44% had some access to equipment, and 32% had ever purchased a first-aid kit. Before training, participants answered 45% of test questions correctly (mean %) and this increased to 86% after training (p < 0.0001).

Conclusions

Lay people witness many emergencies and deaths in Kampala, Uganda and provide much needed care but are ill-prepared to do so. A context-appropriate prehospital trauma care course can be developed and improve lay people’s knowledge of basic trauma care. The effectiveness of such a training program needs to be evaluated prospectively.

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References

  1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367(9524):1747–1757

    Article  PubMed  Google Scholar 

  2. Mathers CD, Loncar D (2030) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11):e442

    Article  Google Scholar 

  3. The global burden of disease: 2004 update. Geneva: WHO2008

  4. Hofman K, Primack A, Keusch G, Hrynkow S (2005) Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health 95:13–17

    Article  PubMed  Google Scholar 

  5. Murray CJL, Lopez AD (1996) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press, Cambridge

    Google Scholar 

  6. Murray CJL, Lopez AD (1996) Global health statistics: a compendium of incidence prevalence and mortality estimates for over 200 conditions. Harvard University Press, Cambridge

    Google Scholar 

  7. Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 44:804–814

    Article  CAS  PubMed  Google Scholar 

  8. WHO (2004) World report on road traffic injury prevention. World Health Organization, Geneva

    Google Scholar 

  9. Debas HT, Gosselin R, McCord C, Thind A (2006) Surgery. In: Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York

    Google Scholar 

  10. Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M (2006) Evaluation of Trauma Care capabilities in four countries using the WHO-IATSIC Guidelines for Essential Trauma Care. World J Surg 30:946–956

    Article  PubMed  Google Scholar 

  11. Ministry of Health Epidemiology Unit C, Planning Unit (1996) Burden of disease, cost-effectiveness analysis and five year projections in thirteen districts of Uganda. Uganda Ministry of Health and United States Centers for Disease Control and Prevention, Entebbe, Uganda

    Google Scholar 

  12. Kobusingye OC, Guwatudde D, Owor G, Lett RR (2002) Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev 8:133–136

    Article  CAS  PubMed  Google Scholar 

  13. Mock CN, nii-Amon-Kotei D, Maier RV (1997) Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 42:504–513

    Article  CAS  PubMed  Google Scholar 

  14. Kobusingye OC, Lett RR (2000) Hospital-based trauma registries in Uganda. J Trauma 48:498–502

    Article  CAS  PubMed  Google Scholar 

  15. Mock C, Lormand J, Goosen J, Joshipura M, Peden M (2004) Guidelines for essential trauma care. World Health Organization, Geneva

    Google Scholar 

  16. WHO (2005) Prehospital trauma care systems. World Health Organization, Geneva

    Google Scholar 

  17. Kobusingye O, Hyder A, Bishai B, Joshipura M, Romero Hicks E, Mock C (2006) Emergency medical services. In: Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York

    Google Scholar 

  18. Mock CN, Tiska M, Adu-Ampofo M, Boakye G (2002) Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 53:90–97

    Article  PubMed  Google Scholar 

  19. Tiska MA, Adu-Ampofo M, Boakye G, Tuuli L, Mock CN (2004) A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J 21:237–239

    Article  CAS  PubMed  Google Scholar 

  20. Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M (2003) Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma 54:1188–1196

    Article  PubMed  Google Scholar 

  21. Kampala City Council District Profile. Kampala, Uganda. http://www.kcc.go.ug/city_council_of_kampala_directorates_downloads.asp

  22. Kobusingye O, Hyder A, Bishai B, Joshipura M, Romero Hicks E, Mock C (2006) Emergency medical systems. In: Jamison DT et al (eds) Disease control priorities in developing countries, 2nd edn. World Bank,

    Google Scholar 

  23. Husum H, Gilbert M, Wisborg T (2003) Training pre-hospital trauma care in low-income countries: the ‘Village University’ experience. Med Teach 25:142–148

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful for unrestricted project funding from the Hellman Foundation and The Laura Case Trust to pursue this study, and sincerely thank the following contributors who gave valuable assistance at during various stages of this project: Dr. James Suozzi, Moses Dumba from the Ugandan Taxi Operators and Drivers Association; Red Cross First-Aid Instructors: Robert Okuyat, Juliet Kiyimba, Ivan Luwaga, and Daniel Nsubuga; Red Cross Volunteer: Yusuf Kimbowa; Sarah Nakitto, Research Coordinator, Chris Hartley-Sharpe from London Ambulance Service; Dr. Charles Mock and Dr. Olive Kobusingye. The authors also thank the UCSF Department of Surgery Scientific Publications Manager, Pamela Derish, for editorial support. This project was conducted using an unrestricted gift from the Hellman Family Foundation, which had no role in study design, analysis, writing of the report, or decision to submit for publication.

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Authors and Affiliations

  1. Department of Surgery, University of California San Francisco, 513 Parnassus Ave, S321, San Francisco, CA, 94118, USA

    Sudha Jayaraman

  2. Department of Accident and Emergency, Mulago Hospital and Makerere University, Kampala, Uganda

    Jacqueline R. Mabweijano & Robert Wangoda

  3. Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Michael S. Lipnick

  4. School of Medicine, Office of Medical Education, University of California San Francisco, San Francisco, CA, USA

    Nolan Caldwell & Justin Miyamoto

  5. Department of Anaesthesia, Mulago Hospital and Makerere University, Kampala, Uganda

    Cephas Mijumbi

  6. Department of Emergency Medicine, University of California San Francisco, 505 Parnassus Avenue, Room M-24, San Francisco, CA, 94143-0203, USA

    Renee Hsia

  7. Department of Surgery, San Francisco General Hospital, Ward 3-A, 1001 Potrero Avenue, San Francisco, CA, 94110, USA

    Rochelle Dicker

  8. Division of Pediatric Surgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Doruk Ozgediz

Authors
  1. Sudha Jayaraman
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  2. Jacqueline R. Mabweijano
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  3. Michael S. Lipnick
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  4. Nolan Caldwell
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  5. Justin Miyamoto
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  6. Robert Wangoda
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  7. Cephas Mijumbi
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  8. Renee Hsia
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  9. Rochelle Dicker
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  10. Doruk Ozgediz
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Corresponding author

Correspondence to Doruk Ozgediz.

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Jayaraman, S., Mabweijano, J.R., Lipnick, M.S. et al. Current Patterns of Prehospital Trauma Care in Kampala, Uganda and the Feasibility of a Lay-First-Responder Training Program. World J Surg 33, 2512–2521 (2009). https://doi.org/10.1007/s00268-009-0180-6

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  • DOI: https://doi.org/10.1007/s00268-009-0180-6

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