Academic journal article Bulletin of the World Health Organization

Strengthening Care of Injured Children globally/Renforcement Des Soins Aux Enfants Victimes De Traumatismes Dans le monde/Fortalecimiento Mundial De la Asistencia a Las Lesiones Infantiles

Academic journal article Bulletin of the World Health Organization

Strengthening Care of Injured Children globally/Renforcement Des Soins Aux Enfants Victimes De Traumatismes Dans le monde/Fortalecimiento Mundial De la Asistencia a Las Lesiones Infantiles

Article excerpt

Introduction

Injury has become a leading cause of death and disability globally. The two age groups most affected are older children (aged 5-14 years) and adolescents and younger adults (aged 15-44). For every person injured, many more are left with temporary or lifelong disabilities. The burden of injury is especially pronounced in low- and middle-income countries (LMICs), where 95% of all childhood injury deaths occur. (1)

To decrease this burden, a spectrum of activities are needed, including injury surveillance, injury prevention and improvements in care of the injured (e.g. trauma care). Obviously, a major emphasis should be on prevention. However, much can also be accomplished by improvements in trauma care. To gauge the potential extent of such gains, we can examine existing discrepancies in outcome of injured patients in different countries. One study comparing outcomes of severely injured patients in three countries at different economic levels showed that case-fatality rates among seriously injured persons (i.e. with an Injury Severity Score [greater than or equal to] 9) increased from 35% in high-income United States of America to 55% in middle-income Mexico to 63% in low-income Ghana. These results show that people injured to a similar extent are nearly twice as likely to die in a low-income setting as in a high-income setting. (2) If these inequities could be eliminated, an estimated 2 million of the 5 million injury deaths each year could be averted.

In addition to mortality, there is also a large burden of avoidable disability globally. The majority of injury-related disability in LMICs is due to extremity injuries, as opposed to high-income countries where there is a relatively higher burden from more difficult to treat head and spinal cord injuries. The disability from extremity injuries should be eminently amenable to low-cost improvements in orthopaedic care and rehabilitation. (3,4)

There is often a misperception that improvements in trauma care would be expensive and impractical in LMICs. However, the Disease Control Priorities Project has shown that several interventions that need to be promoted to improve trauma care are among the most cost-effective in the health-care armamentarium. Among these, the following interventions were identified as having cost-effectiveness ratios of below 100 (US$ 100 per disability-adjusted life year averted): strengthening of prehospital care through training of community-based paramedics and village lay-first responders; community ambulances; and basic surgical care (including care of injuries) at district hospitals. Thus, these interventions are considered extremely cost-effective when assessed on a scale ranging from 1 (most cost-effective) to 100 000 (least cost-effective). (5)

In this paper, we address how to better implement the array of cost-effective and sustainable trauma care improvements globally, especially regarding care of the injured child. First, we review some of the recent individual country efforts that specifically address care of the injured child in the LMIC setting. We show that there are many capable individuals successfully confronting barriers and difficulties in their own institutions, some with innovative solutions from which others around the world can learn. We will then discuss how to build on such individual examples to make more progress globally. We conclude with practical steps that can be taken to reduce the currently unacceptable burden of death and disability from childhood injury.

Progress in individual institutions and countries

It has long been recognized that injured children are not just small injured adults. Although some of the same general principles of trauma care do apply, there are many specific considerations for children that need to be addressed, such as paediatric-size equipment, modifications in technique for airway maintenance, differences in calculation of fluid requirements for shock resuscitation, among many others. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.