THE NEED
The World Health Organization states that injuries and violence account for 10% of global
mortality, and injury is a larger global killer than HIV/AIDS, malaria and tuberculosis combined. More than two-thirds of deaths due to injury occur in developing countries, where trauma is the leading cause of death in the first four decades of life. Motor vehicle collisions in urban areas and penetrating trauma in rural areas are the most common mechanisms of injury in developing countries. Trauma patients often die before they are able to access the appropriate services at a major hospital center, due to a combination of infrastructural gaps and disorganized trauma management protocols and practices. The appropriate management of traumatic injury necessitates a coordinated supply chain of preventative measures, pre-hospital care, hospital care with appropriate infrastructure, post-hospital rehabilitative care, and long-term monitoring and surveillance improve every node in this chain. Some standardized protocols exist for some nodes of the trauma supply chain, such as Advanced Trauma Life Support (ATLS), the global gold-standard for in-hospital training of healthcare personnel in the timely diagnosis and management of traumatic injury. Unfortunately, ATLS has been historically difficult to implement into Sub-Saharan Africa, until the work undertaken by this initiative.
The exact distribution of deficits in this complex supply chain of trauma management vary by country, necessitating detailed needs assessments to elucidate and differentiate them. In Kenya, ICChange assessment has determined that, regardless of objective deficits in healthcare infrastructure relative to Canadian equivalents, the biggest barriers to improved trauma care in Kenya are related to a lack of assessment of the present situation as well as the integration of health system components. For example, the majority of trauma-related deaths in Kenya occur in the pre-hospital environment, due to “scoop-and’run” ambulance practices and inadequate training of paramedical personnel. Building solutions to issues like this is further complicated by the lack of trauma incidence and severity reporting, such that decision-makers in the Kenyan healthcare space are not equipped with the right data to make informed policy changes to tackle the issue of traumatic injury in their jurisdictions.
Effective trauma management at every node of the trauma supply chain necessitates oversight by a national authority that implements a coordinated framework to improve trauma training, facilitating the improved utilization of existing infrastructure and developing new and specialized centers for trauma care including a national trauma hospital. Without this, traumatic injury will persist as a major cause of preventable injury, disability, and death worldwide, and disproportionately so in developing countries.
Trauma and injury
Pre-hospital care
Hospital care
Post-hospital care
Preventative measures
Monitoring and surveillance
OUR SOLUTION AND PROGRESS
The Kenya Trauma and Injury Program (KTIP) is a longitudinal collaboration headed by ICChange in which major players in Kenyan healthcare and international trauma experts have come together to create a comprehensive framework for the improvement of trauma management in Kenya.
52MKenyans served by a comprehensive trauma management framework incorporated into nationwide policy by the Kenyan Ministry of Health.
KTIP began with an extensive needs assessment of the Kenyan healthcare system including geographic injury surveillance around the two largest tertiary referral centres in Kenya, the Moi Teaching and Referring Hospital and the Kenyatta National Hospital.
After elucidating the various deficits at the different nodes of the trauma management supply chain, we created novel component solutions to each of these deficits that were consolidated into a comprehensive trauma management framework eventually published by the Kenyan Ministry of Health as the Kenya National Framework for the Organization of Trauma Services - Saving Lives: Universal Access to Trauma Services in Kenya in 2021, which informs Kenyan policy and legislature across the country to this day.
Multimodal Approach to Building a Trauma Management Framework
A Geographic Information System (GIS) of available healthcare facilities with potential for becoming trauma care hubs was compiled across the country.
KTIP established the world’s first successful promulgation of ATLS in Sub-Saharan Africa.
Obtention of official permission from the American College of Surgeons for use of affordable trauma simulators in a low-to-middle-income country.
Trauma and injury
Pre-hospital care
Hospital care
Post-hospital care
Preventative measures
Monitoring and surveillance
Creation and registration of the Trauma Society of Kenya, a national body of injury professionals that serves as the platform for all future improvements to the components of Kenya's growing robust, decentralized trauma management framework.
Created an Orthopedic Trauma Readiness Assessment Tool in use in Kenya and discussed at academic meetings.
Led a prospectus study comparing orthopedic trauma management practices between Moi Teaching and Referral Hospital and a large Canadian trauma hospital
GROWTH ROADMAP
Leverage status as the first successful sub-saharan promulgation of ATLS to become a launchpad for other African countries to implement ATLS with minimal redundancy.
1.
Implement a real-time GIS-enabled asset management system and trauma registry with an online portal for improved trauma monitoring and surveillance.
2.
Expand the Trauma Society of Kenya to structure trauma education, care practices, and act on longitudinal trauma trends and to serve has a model for neighbour countries in East Africa.
3.
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Prevent, track, and treat trauma and injury at a scale that benefits millions.