External injuries, trauma and avoidable deaths in Agincourt, South Africa

a retrospective observational and qualitative study

Idara J Edem, Anna J Dare, Peter Byass, Lucia D'Ambruoso (Corresponding Author), Kathleen Kahn, Andy J M Leather, Stephen Tollman, John Whitaker, Justine Davies

Research output: Contribution to journalArticle

Abstract

Objective Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.

Setting Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.

Participants Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.

Methods A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the ‘three delays framework’ (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs—a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.

Results Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.

Conclusions A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.
Original languageEnglish
Article numbere027576
JournalBMJ Open
Volume9
Issue number6
Early online date4 Jun 2019
DOIs
Publication statusPublished - Jun 2019

Fingerprint

South Africa
Observational Studies
Wounds and Injuries
Autopsy
Health Personnel
Health
Referral and Consultation
Interviews
Aptitude
Quality of Health Care
Consciousness
Demography

Keywords

  • South Africa
  • avoidable death
  • rural
  • trauma
  • verbal autopsy
  • MORTALITY
  • SYSTEMS
  • HEALTH
  • BURDEN
  • PREHOSPITAL DEATHS
  • CARE
  • PREVENTABLE DEATHS

ASJC Scopus subject areas

  • Medicine(all)

Cite this

External injuries, trauma and avoidable deaths in Agincourt, South Africa : a retrospective observational and qualitative study. / Edem, Idara J; Dare, Anna J; Byass, Peter; D'Ambruoso, Lucia (Corresponding Author); Kahn, Kathleen; Leather, Andy J M; Tollman, Stephen; Whitaker, John; Davies, Justine.

In: BMJ Open, Vol. 9, No. 6, e027576, 06.2019.

Research output: Contribution to journalArticle

Edem, Idara J ; Dare, Anna J ; Byass, Peter ; D'Ambruoso, Lucia ; Kahn, Kathleen ; Leather, Andy J M ; Tollman, Stephen ; Whitaker, John ; Davies, Justine. / External injuries, trauma and avoidable deaths in Agincourt, South Africa : a retrospective observational and qualitative study. In: BMJ Open. 2019 ; Vol. 9, No. 6.
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title = "External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study",
abstract = "Objective Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.Setting Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.Participants Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.Methods A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the ‘three delays framework’ (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs—a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.Results Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40{\%}) avoidable EIDs and 78 (30{\%}) avoidable trauma deaths (41{\%} of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61{\%}) and trauma deaths (59{\%}), followed by delay in seeking care (24{\%} and 23{\%}) and in reaching care (15{\%} and 18{\%}). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.Conclusions A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.",
keywords = "South Africa, avoidable death, rural, trauma, verbal autopsy, MORTALITY, SYSTEMS, HEALTH, BURDEN, PREHOSPITAL DEATHS, CARE, PREVENTABLE DEATHS",
author = "Edem, {Idara J} and Dare, {Anna J} and Peter Byass and Lucia D'Ambruoso and Kathleen Kahn and Leather, {Andy J M} and Stephen Tollman and John Whitaker and Justine Davies",
note = "Funding for part of this project (travel scholarship) was provided by the King’s College London, Centre for Global Health. The research presented in this paper was in part funded by the Health Systems Research Initiative from the Department for International Development (DFID)/ Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1). These funding sources were not involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the manuscript; and in the decision to submit the paper for publication.",
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T2 - a retrospective observational and qualitative study

AU - Edem, Idara J

AU - Dare, Anna J

AU - Byass, Peter

AU - D'Ambruoso, Lucia

AU - Kahn, Kathleen

AU - Leather, Andy J M

AU - Tollman, Stephen

AU - Whitaker, John

AU - Davies, Justine

N1 - Funding for part of this project (travel scholarship) was provided by the King’s College London, Centre for Global Health. The research presented in this paper was in part funded by the Health Systems Research Initiative from the Department for International Development (DFID)/ Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1). These funding sources were not involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the manuscript; and in the decision to submit the paper for publication.

PY - 2019/6

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N2 - Objective Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.Setting Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.Participants Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.Methods A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the ‘three delays framework’ (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs—a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.Results Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.Conclusions A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.

AB - Objective Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.Setting Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.Participants Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.Methods A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the ‘three delays framework’ (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs—a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.Results Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.Conclusions A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.

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KW - trauma

KW - verbal autopsy

KW - MORTALITY

KW - SYSTEMS

KW - HEALTH

KW - BURDEN

KW - PREHOSPITAL DEATHS

KW - CARE

KW - PREVENTABLE DEATHS

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