N. Lin1,2, O. Nwanna-Nzewunwa1, M. Carvalho1, A. M. Margaret3, A. E. Wange3, G. Motwani1, L. Gwynn2, R. A. Dicker1, C. Juillard1 1University Of California – San Francisco,Center For Global Surgical Studies,San Francisco, CA, USA 2University Of Miami,Miami, FL, USA 3Soroti Regional Referral Hospital,Soroti, SOROTI, Uganda
Introduction: Delayed access to surgical care leads to increased mortality and disability, disparately affecting low- and middle- income countries. The Lancet Commission on Global Surgery (LCoGS) defines 2 dimensions of access to surgical care: 1) reaching a surgical provider within 2 hours and 2) receiving appropriate care from that provider. This study aims to evaluate trauma care access as defined by these dimensions in the catchment area of the regional referral hospital (RRH) in Northeastern Uganda. Understanding local barriers and delays can inform contextual public health strategies and resource allocation to strengthen access.
Methods: We 1) evaluated trauma care capacity and resources at first-level district health facilities in the region using the WHO’s Tool for Situational Analysis to Assess EESC, and 2) surveyed a consecutive sample of trauma patients upon arrival at the RRH to obtain demographic, geographical, temporal, and clinical information about their injury and access to trauma care. A Wilcoxon rank-sum test was used to compare time taken to reach 1) 1st care site and 2) RRH with LCoGS threshold.
Results: The study region had eight public district hospitals with an average of 85.3 beds, 0.38 surgeons, 1.88 general doctors, 0.88 anesthetic care providers, and 7.8 paramedics/midwives per facility. Few facilities consistently had a working anesthesia machine (37.5%), oxygen supply (37.5%), running water (25%), electricity and/or generator (12.5%). All facilities could provide basic resuscitation and first aid, but none could do advanced trauma care procedures. None had a blood bank or intensive care unit. Frequent shortages of supplies (gloves, gauze) occurred. Five facilities had an ambulance.
We surveyed 131 trauma patients at RRH age 1-81 years. Falls (43%), road traffic accidents (33%), blunt force (17%), penetrating trauma (5%), and burns (2%) were the mechanisms of injury. First responders were relatives (46%), bystanders (39%), and friends (12%). Transportation to care site was via motorcycle/taxi (64%), ambulance/police (13%) and private car (10%). Median time to reach 1st care site, 1h [IQR 0.6 – 2h], was less than LCoGS threshold (p< 0.0001). However, median time to reach RRH, 6h [IQR 1 – 65h], was more than LCoGS threshold (p<0.0001) and time to reach 1st care site (p<0.0001). Median cost of patient navigation to RRH was $2.28 [IQR $0.56 – 8.33]. 19.8% of patients sought care at a primary care site and 13.7% at a district hospital before reaching RRH.
Conclusion: District hospitals in Northeastern Uganda lack staff, resources, and transport for adequate surgical trauma care. Many patients experience time delay when accessing trauma care at RRH. Proper resource allocation, increased training, and quality improvement efforts at the district level may improve timely access and availability for trauma patients in this region.