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Original Investigation |

Serial Assessment of Trauma Care Capacity in Ghana in 2004 and 2014

Barclay T. Stewart, MD, MScPH1,2,3; Robert Quansah, MD, PhD2,4; Adam Gyedu, MD, MPH2,4; Godfred Boakye, BSc2; Francis Abantanga, MD2,4; James Ankomah, MBChB, MPH2; Peter Donkor, MDSc2,4; Charles Mock, MD, PhD3,5,6
[+] Author Affiliations
1School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
2Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
3Department of Surgery, University of Washington, Seattle
4School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
5Harborview Injury Prevention and Research Center, Seattle, Washington
6Department of Global Health, University of Washington, Seattle
JAMA Surg. 2016;151(2):164-171. doi:10.1001/jamasurg.2015.3648.
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Importance  Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed.

Objective  To compare the availability of trauma care resources in Ghana between 2004 and 2014 to assess the effects of a decade of change in the trauma care landscape and derive recommendations for improvements.

Design, Setting, and Participants  Capacity assessments were performed using direct inspection and structured interviews derived from the World Health Organization’s Guidelines for Essential Trauma Care. In Ghana, 10 hospitals in 2004 and 32 hospitals in 2014 were purposively sampled to represent those most likely to care for injuries. Clinical staff, administrators, logistic/procurement officers, and technicians/biomedical engineers who interacted, directly or indirectly, with trauma care resources were interviewed at each hospital.

Main Outcomes and Measures  Availability of items for trauma care was rated from 0 (complete absence) to 3 (fully available). Factors contributing to deficiency in 2014 were determined for items rated lower than 3. Each item rated lower than 3 at a specific hospital was defined as a hospital-item deficiency. Scores for total number of hospital-item deficiencies were derived for each contributing factor.

Results  There were significant improvements in mean ratings for trauma care resources: district-level (smaller) hospitals had a mean rating of 0.8 for all items in 2004 vs 1.3 in 2014 (P = .002); regional (larger) hospitals had a mean rating of 1.1 in 2004 vs 1.4 in 2014 (P = .01). However, a number of critical deficiencies remain (eg, chest tubes, diagnostics, and orthopedic and neurosurgical care; mean ratings ≤2). Leading contributing factors were item absence (503 hospital-item deficiencies), lack of training (335 hospital-item deficiencies), and stockout of consumables (137 hospital-item deficiencies).

Conclusions and Relevance  There has been significant improvement in trauma care capacity during the past decade in Ghana; however, critical deficiencies remain and require urgent redress to avert preventable death and disability. Serial capacity assessment is a valuable tool for monitoring efforts to strengthen trauma care systems, identifying what has been successful, and highlighting needs.

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Figure 1.
Changes in Availability of Trauma Care Services and the Resources Necessary to Provide Them Between 2004 and 2014 in Ghana

FAST indicates focused assessment with sonography for trauma.

aMean item availability rating was 0 in both assessments at district-level and/or regional hospitals.

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Figure 2.
Factors Contributing to Hospital-Item Deficiencies for Services and Resources for Trauma Care in 2014 Compared With 2004 in Ghana

Hospital-item deficiency was defined as an item with a rating less than 3 at a specific hospital.

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