Analysis of a National Trauma Registry in Cameroon: Implications for Prehospital Care Strengthening
Catherine Juillard, Rochelle Dicker, Obieze C Nwanna-Nzewunwa, S. Ariane Christie, Melissa Carvalho, Girish Motwani, Fanny N Dissak Delon, Marquise K Ngamby, Georges A E Mballa, Pierre Nsongoo, Arabo Saidou, David Mekolo
Keywords :
Cameroon, Emergency medical services, Global surgery, Injury epidemiology, Low income countries, Prehospital care, Public health, Sub-Saharan Africa, Trauma registry
Citation Information :
Juillard C, Dicker R, Nwanna-Nzewunwa OC, Christie SA, Carvalho M, Motwani G, Delon FN, Ngamby MK, Mballa GA, Nsongoo P, Saidou A, Mekolo D. Analysis of a National Trauma Registry in Cameroon: Implications for Prehospital Care Strengthening. Panam J Trauma Crit Care Emerg Surg 2018; 7 (2):133-142.
Introduction: About 54% of all injury deaths in developing counties are attributable to lack of prehospital care. The study aims to ascertain the current state, determinants, and opportunities for strengthening prehospital care delivery in Cameroon
Methods: From July 2015 to January 2017, Cameroon Trauma Registry was implemented simultaneously at Laquintinie Hospital of Doula, Limbe Regional Hospital, and Catholic Hospital Pouma. Data was subjected to descriptive and inferential analysis. A multiple logistic regression models was built to predict getting prehospital care.
Results: The 7879 patients were mostly male (72.6%), urban dwellers (94%), self-employed (39%) averaging 31.4 years (SD = 15.5). The commonest causes of injury were road traffic crashes (53%), blunt force (15%) and falls (15%). About 669 (9%) patients got prehospital care such as hemostasis (55.3%), fracture immobilization (24%), repositioning (10%), and giving fluid infusions (8%). Friends (35.8%), medical personnel (30.4%), or passersby (20.2%) provided prehospital care. Transport was via taxis (56%), motorcycles (18%), and private vehicles (16%). Predictors of getting prehospital care were injuries at school (perfect predictor), home (OR = 3.10, p < 0.0001), public places (OR = 3.79, p < 0.0001), or distance. 5 km from the hospital (OR = 4.06, p < 0.0001), and rural residence (OR = 4.43, p < 0.0001).
Discussion: Prehospital care is typically provided by untrained laypersons in rural and distant areas, and schools. Formal lay provider training may improve prehospital care capacity and access and can drive health system growth.
Conclusion: Formal prehospital trauma systems are limited in Cameroon. Prehospital care development can drive health system growth. Study findings and literature suggest that prehospital trauma care delivery can be improved by leveraging and training lay first-responders to provide prehospital care.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev (Internet). 2015;1-16. Available from: http:// injuryprevention.bmj.com/content/early/2015/10/20/ injuryprev-2015-041616.abstract
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev J Int Soc Child Adolesc Inj Prev. 2016 Feb;22(1):3-18.
Gosselin R, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. lletin World Heal Organ.
World Health Organization. Statistical Annex of the World Health Report 2004. Geneva: WHO Department of Measurement and Health Information; 2004.
Mock CN, Jurkovich GJ, Nii-Amon-Kotei D, Arreola-Risa C, Maier R V. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-812.
Kobusingye OC, Hyder A a., Bishai D, Joshipura M, Hicks ER, Mock C. Chapter 68: Emergency Medical Services. Dis Control Priorities Dev Ctries. 2006;1261-1279.
Sakran J V, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med (Internet). 2012;20(1):64. Available from: http://sjtrem.biomedcentral. com/articles/10.1186/1757-7241-20-64
Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN. Disease Control Priorities, 3rd Edition: Volume 1: Essential Surgery (Internet). World Bank. 2015. Available from: https://openknowledge.worldbank.org/ handle/10986/21568
Chowdhury S. In an emergency... The Hindu (Internet). Hyderabad; 2002; Available from: http://www.thehindu.com/ thehindu/mp/2002/06/13/stories/2002061300180300.htm
Anand LK, Singh M, Kapoor D. Prehospital trauma care services in developing countries. Anaesthesia, Pain Intensive Care (Internet). 2013;17(1):65–70. Available from: http:// www.apicareonline.com/review-article-prehospital-traumacare- services-in-developing-countries/
Sasser S, Varghese M, Kellerman A, Lormand J. Prehospital Trauma Care Systems. Geneva: World Health Organization; 2005.
Mock C, Lormand J, Goose J, Joshipura M, Peden M. Guidelines for e sential trauma care. World Heal Organ. 2004;
Henry JA, Reingold AL. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2012 Jul;73(1): 261-268.
Bhatti JA, Waseem H, Razzak JA, Shiekh N-U-L, Khoso AK, Salmi L-R. Availability and quality of prehospital care on Pakistani interurban roads. Ann Adv Automot Med. 2013;57:257–264.
Mock CN, Tiska M, Adu-Ampofo M, Boakye G. Improvements in Prehospital Trauma Care in an African Country with no Formal Emergency Medical Services. J Trauma. 2002;53: 90-97.
Mould-Millman NK, Sasser SM, Wallis LA. Prehospital research in sub-Saharan Africa: Establishing research tenets. Acad Emerg Med. 2013;20(12):1304-1309.
MacFarlane C, Benn C a. Evaluation of emergency medical services systems: a classification to assist in determination of indicators. Emerg Med J. 2003;20:188-191.
Ro YS, Shin S Do, Jeong J, Kim MJ, Jung YH, Kamgno J, et al. Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study. BMJ Open (Internet). 2017;7(2):e014573. Available from: http://bmjopen.bmj.com/lookup/doi/10.1136/ bmjopen-2016-014573%5Cnhttp://www.ncbi.nlm.nih.gov/ pubmed/28167749%5Cnhttp://www.pubmedcentral.nih. gov/articlerender.fcgi?artid=PMC5293974
Wikipedia. Laquintinie Hospital (Internet). Wikipedia. 2017 (cited 2017 Oct 20). Available from: https://fr.wikipedia.org/ wiki/Hôpital_Laquintinie
Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O. Injury Surveillance Guidelines. Who. 2001;(1):1–91.
Hyder AA, Sugerman DE, Puvanachandra P, Razzak J, El- Sayed H, Isaza A, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. 2009 May;87(5):345–352.
Kobusingye OC, Lett RR. Hospital-based trauma registries in Uganda. J Trauma. 2000 Mar;48(3):498-502.
Labinjo M, Juillard C, Kobusingye OC, Hyder AA. The burden of road traffic injuries in Nigeria: results of a populationbased survey. Inj Prev J Int Soc Child Adolesc Inj Prev. 2009 Jun;15(3):157-162.
QuesGen Systems Inc. QuesGen data management for clincal research (Internet). San Francisco: Ques Gen Systems Inc; Available from: https://www.quesgen.com/
Microsoft Corporation. Microsoft Excel. Redmond, WA; 2011.
Stata Corp. Stata Statistical Software: Release 13. College Station, TX: Stata Corp, LP; 2013.
Juillard C, Etoundi Mballa GA, Bilounga Ndongo C, Stevens KA, Hyder AA. Patterns of injury and violence in Yaounde Cameroon: an analysis of hospital data. World J Surg (Internet). 2011;35(1):1–8. Available from: http://www.ncbi.nlm. nih.gov/pubmed/21046382
Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, Juillard C. Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon. PLoS One. 2017;12(7).
Juillard CJ, Stevens KA, Monono ME, Mballa GAE, Ngamby MK, McGreevy J, et al. Analysis of prospective trauma registry data in Francophone Africa: a pilot study from Cameroon. World J Surg. 2014 Oct;38(10):2534-2542.
Tolefac PN, Nana TN, Chichom AM, et al. Challenges in Emergency Medical Services in a Resource Limited Setting in Sub-Sahara Africa; Perspectives from Cameroon: a Review Article. Int Ann Med. 2017;11(10).
Smith RM, Conn AK. Prehospital care - Scoop and run or stay and play? Injury. 2009;40(SUPPL. 4).
Haas B, Nathens AB. Pro/con debate: is the scoop and run approach the best approach to trauma services organization? Crit Care (Internet). 2008;12(5):224. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/18828868%5Cnhttp:// www.pubmedcentral. nih.gov/articlerenderfcgi?artid= PMC2592727
Sumaila AF. Road crashes trends and safety management in Nigeria. J Geogr Reg Plan. 2013;6(3):53-62.
Wikipedia. Federal Road Safety Corps (Nigeria) (Internet). Wikipedia. 2017 (cited 2017 Oct 28). Available from: https:// en.wikipedia.org/wiki/Federal_Road_Safety_Corps_ (Nigeria)
Callese TE, Richards CT, Shaw P, Schuetz SJ, Issa N, Paladino L, et al. Layperson trauma training in low- and middleincome countries: a review. J Surg Res. 2014 Jul;190(1): 104-110.
Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg. 2009;33(12):2512-2521.
Geduld H, Wallis L. Taxi driver training in Madagascar: the first step in developing a functioning prehospital emergency care system. Emerg Med J EMJ. 2011 Sep;28(9): 794-796.
Roy N, Murlidhar V, Chowdhury R, Patil SB, Supe P a, Vaishnav PD, et al. Where there are no emergency medical services-prehospital care for the injured in Mumbai, India. Prehosp Disaster Med. 2010;25(April):145-151.
Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma (Internet). 2003;54(6):1188-
Available from: http://www.ncbi.nlm.nih.gov/ pubmed/12813342
Tiska MA. A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J (Internet). 2004;21(2):237-239. Available from: http://emj.bmj.com/cgi/ doi/10.1136/emj.2002.002097
Razzak JA, Kellermann AL. Emergency medical care in developing countries: Is it worthwhile? Bulletin of the World Health Organization. 2002. p. 900-905.
Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS One. 2009;4(9):e6955.
Sepulveda J, Jameson D, et al. Foreword in: Disease Control Priorities in Developing Countries (Internet). 2nd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; New York: Oxford University Press; 2006. Available from: https://www.ncbi.nlm.nih. gov/books/NBK11757/
Sepulveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Ol??iz G, et al. Improvement of child survival in Mexico: the diagonal approach. Lancet. 2006. p. 2017–27.
Reynolds B. Stop the Bleed: A call to action. Journal of the American Academy of Physician Assistants. 2016. p. 12.
Association AH. Part 4: Adult Basic Life Support. Circulation (Internet). 2005;112(24_suppl):IV-19-IV-34. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/CIRCULATIONAHA. 105.166553