11 November 2021

Any incident with many casualties places stress on the medical care system. This is particularly the case in low-income countries with limited hospital capacity. Researchers at Linköping University have now been able to review major incidents in Rwanda, Africa, using a new method.

Photo of hospital in Rwanda.
Hospital in Rwanda.
“The healthcare systems of low-income countries generally have very low reserve capacity. A bus accident with four severely injured people can be a huge burden on a hospital. It doesn’t take much to push a hospital, which may have as few as ten doctors and a single specialist to cover a catchment area with a million people, over the edge”, says Lotta Velin, PhD student in global surgery at the Centre for Teaching & Research in Disaster Medicine and Traumatology at Linköping University.

It is vital to collect data about incidents in low-income countries, to be able to build up a locally adapted preparedness in the healthcare system. The researchers in this pilot study have used news reports to provide medically relevant information when developing clinical operations and creating preparedness:
“We can see, for example, that an individual patient has been involved in an incident with several others injured, the type of incident that occurred and where it took place”, says Lotta Velin.

The LiU researchers have used the Nexis Uni search engine. This has previously been used in such fields as political research, but not for epidemiological surveys. In attempts to describe the epidemiology of major incidents (such as their frequency, types and trends), the researchers carried out a systematic media review, looking for data from Rwandan and international news sources, published in three languages during the period 2010-2020.

“This method is revolutionary. Data of this type have not been gathered into any databases. We can then link the information from the media with, for example, information on the expertise that is available at the hospitals to which the patients are taken. This can be decisive for the possibilities of organising the healthcare system and increasing patient survival”, says Laura Pompermaier, surgeon and physician at the Hand and Plastic Surgery Clinic in Linköping, and senior researcher in global surgery.

“The conditions in many low-income countries are similar to those in Rwanda. But we believe that the method can also be used in high-income countries in, for example, Europe”, she adds.

They have surveyed 117 major incidents, described in 247 media reports. The number of fatalities was stated in more than 97% of cases, while the number injured was reported in around 80%. The hospital to which the injured were transported is also commonly reported.

“As many as 29 of Rwanda’s 30 districts were hit by a major incident during this period, but some districts are more incident-prone than others”, says Lotta Velin. Many of them are located far from the capital, Kigali, where the largest hospitals are located.

A definition of a special incident or disaster has not been established in Rwanda. This meant that the researchers imposed certain limits. The types of incident were concentrate to incidents with three or more injured, in three categories: road-traffic accidents, natural disasters, and “man-made events”. The third category covers such phenomena as gun-based violence and acts of terrorism.

“Rwanda is a relatively safe country, compared with other countries in the region. The man-made events were principally isolated incidents. In the article, we focus on what appear to be the serious problems: road-traffic accidents and natural disasters.”

Road-traffic accidents and other incidents that require surgery are the most common cause of death in young people in many low-income countries. The systematic review has revealed that natural disasters, such as landslides and flooding, are becoming more frequent causes of major incidents. And this appears to be the only category for which the frequency increased during the period studied.
“We believe this is linked to climate change. And this is why we are convinced that the medical care system must improve its preparedness for natural disasters.”

The field of global health contains also global surgery, which focusses on equal care for all who need surgical care. Five billion people globally do not have access to safe surgery, should they need it, at a cost that they can afford. The researchers plan to validate the results in a new study, and at the same time ensure that their new knowledge is disseminated in Rwanda.

“This is frequently seen in global health studies, that the knowledge does not reach those who need it. Even research that specifically concerns low and middle-income countries is often produced in the western world. The cost of access to a scientific journal may be around USD 100, which can prevent local clinics and decision makers from reading about research, and thus that the research results cannot be implemented. We want to achieve local ownership, and are therefore working close to our Rwandan colleagues. They are participating in the design of the next project, and will be included as principal authors on the publications”, says Laura Pompermaier.
(Translated by George Farrants)

The study:

Lotta Velin, Mbonyintwari Donatien, Andreas Wladis, Menelas Nkeshimana, Robert Riviello, Jean-Marie Uwitonze, Jean-Claude Byiringiro, Faustin Ntirenganya, Laura Pompermaier: Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases—A pilot study in Rwanda (Plos One, 13 October 2021) https://doi.org/10.1371/journal.pone.0258446

Facts in brief: Global surgery

Global health integrates knowledge and experience from several disciplines such as public health, medicine, epidemiology, health economics, environmental medicine, behavioural science and anthropology.

A new field within global health has developed in recent years: global surgery. Its objective is to achieve equality for all people who need surgical medical care, with a focus on those who live in parts of the world where access to surgery is poorest. Major investment will be needed to reach this ambitious objective.

Huge research initiatives will be needed to ensure that priorities are set correctly, everything from the incidence of certain diseases to the best ways to treat them, and what the final cost will be.
Most of us suffer at some time in life from conditions that require surgical procedures or expertise. Five billion people globally do not have access to safe surgery, should they need it, at a cost that they can afford. Conditions that require surgery are responsible for more than 30% of the global healthcare burden. Countries in sub-Saharan Africa are the most seriously affected, and the risk of dying from such conditions is highest there.

Source: Karolinska institutet


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