Informing road traffic intervention choices in South Africa: the role of economic evaluations

© 2016, © 2016 Hadley K.H. Wesson et al. Introduction: Given the burden of road traffic injuries (RTIs) in South Africa, economic evaluations of prevention interventions are necessary for informing and prioritising public health planning and policy with regard to road safety. Methods: In view of the dearth of RTI cost analysis, and in order to understand the extent to which RTI-related costs in South Africa compare with those in other low- and middle-income countries (LMICs), we reviewed published economic evaluations of RTI-related prevention in LMICs. Results: Thirteen articles were identified, including cost-of-illness and cost-effectiveness studies. Although RTI-related risk factors in South Africa are well described, costing studies are limited. There is minimal information, most of which is not recent, with nothing at all on societ al costs. Cost-effective interventions for RTIs in LMICs include bicycle and motorcycle helmet enforcement, traffic enforcement, and the construction of speed bumps. Discussion: Policy recommendations from studies conducted in LMICs suggest a number of cost-effective interventions for consideration in South Africa. They include speed bumps for pedestrian safety, strategically positioned speed cameras, traffic enforcement such as the monitoring of seatbelt use, and breathalyzer interventions. However, interventions introduced in South Africa will need to be based either on South African cost-effectiveness data or on findings adapted from similar middle-income country settings

The cost of injury and trauma care in low-and middle-income countries: A review of economic evidence

© The Author 2013; all rights reserved. Introduction Injuries are a significant cause of mortality and morbidity, of which more than 90% occur in low- and middle-income countries (LMICs). Given the extent of this burden being confronted by LMICs, there is need to place injury prevention at the forefront of public health initiatives and to understand the costs associated with injury. The aim of this article is to describe the extent to which injury-related costing studies have been conducted in LMICs.Methods A review of literature was performed to explore costing data available for injury and/or trauma care in LMICs. Study quality was described using recommendations from the Community Guide\u27s quality assessment tool for economic evaluations.Results The review identified 68 studies, of which 13 were full economic evaluations. Cost of injury varied widely with mean costs ranging from US$14 to US$17 400. In terms of injury-prevention interventions, cost per disability adjusted life year averted for injury-prevention interventions ranged from US$10.90 for speed bump installation to US$17 000 for drunk driving and breath testing campaigns in Africa. The studies varied in quality, ranging from very good to unsatisfactory.Discussion There is a lack of injury-related economic evidence from LMICs. Current costing research has considerable variability in the costs and cost descriptions of injury and associated prevention interventions. The generalizability of these studies is limited. Yet the economic burden of injury is high, suggesting significant potential for cost savings through injury prevention. A standardized approach to economic evaluation of injury in LMICs is needed to further prioritize investing in injury prevention

Assessing trauma care at the district and provincial hospital levels: A case study of hospitals in Kenya

Trauma is a major cause of death and disability worldwide, of which more than 90% occur in low- and middle-income countries. Given the magnitude of this inequality, there is a need to devise and use tools to assess the capacity of facility-based trauma care. This study used two tools, hospital flowcharts and the World Health Organization\u27s Trauma Care Checklist, to describe trauma care capacity at two hospitals in Kenya and ways in which this capacity can be strengthened. We found these hospitals had a large volume of trauma, but due to the lack of intensive care units, specialized trauma units, and axillary services, such as orthopedics and neurosurgery, the hospitals had a limited ability to provide definitive care for injured patients in critical condition. Additionally, organizational capabilities, such as trauma registries, trauma-specific training, and quality improvement programmes were lacking. The state of trauma care at district and provincial levels in Kenya demonstrates a strong case for national and global investment in clinical and systemic interventions. © 2013 Elsevier Ltd

Trauma systems in Kenya: A qualitative analysis at the district level

© The Author(s) 2015. Injury is a leading cause of death and disability in low- and middle-income countries. Kenya has a particularly high burden of injuries, accounting for 88.4 deaths per 100,000 population. Despite recent attempts to prioritize injury prevention in Kenya, trauma care systems have not been assessed. We assessed perceptions of formal and informal district-level trauma systems through 25 qualitative semi-structured interviews and 16 focus group discussions with Ministry of Health officials, district hospital administrators, health care providers, police, and community members. We used the principles of theoretical analysis to identify common themes of prehospital and hospital trauma care. We found prehospital care relied primarily on good Samaritans and police. We described hospital care in terms of human resources, infrastructure, and definitive care. The interviewers repeatedly emphasized the lack of hospital infrastructure. We showed the need to develop prehospital care systems and strengthen hospital trauma care services

Changing state of pediatric injuries in South Africa: An analysis of surveillance data from a Pediatric Emergency Department from 2007 to 2011

© 2017 Elsevier Inc. Background Pediatric injuries are associated with significant morbidity and mortality, especially in low- and middle-income countries. Data to characterize the cause and risk factors associated with childhood injuries in low- and middle-income countries are very scarce. The aim of this study is to describe the cause of pediatric injuries and their possible changes between 2007 and 2011 using hospital-based data in Cape Town, South Africa. Methods Data from injured children \u3c13 years of age who presented to the Red Cross War Memorial Children\u27s Hospital\u27s emergency department in 2007 and 2011 were captured in Childsafe South Africa\u27s trauma surveillance system. Poisson regression was used to assess changes in rates of injury between 2007 and 2011 in terms of demographics, geographic location of injury, type of injury mechanism, injury severity, and anatomic region of the sustained injury. Results In total, 14,915 injured children with 15,414 injuries presented to Red Cross War Memorial Children\u27s Hospital in 2007 and 2011. The mean age was 5.01 ± 3.5 years and 60.3% were male. Common mechanisms of injury included falls (n = 6,036; 40%), road traffic injuries (n = 1,939; 13%), burns (n = 1,885; 12.6%), and assault (n = 640; 4.3%). Comparing 2011 to 2007, the incidence of road traffic injuries has decreased by 7% (P \u3c.05) while burn injuries increased 11% (P \u3c.05). Seventy-three percent (73%) of injuries that presented to Red Cross War Memorial Children\u27s Hospital occurred in the Cape Flats area of Cape Town, where many informal settlements exist. Conclusion These epidemiologic findings suggest that while road traffic injuries decreased and burn injuries increased at Red Cross War Memorial Children\u27s Hospital, there is a need for data that are population-based and not hospital based. If we could describe injuries accurately within the pediatric population of a city such as Cape Town, we could in turn use this data to strengthen the need for targeted interventions to address risk factors for pediatric injuries. Despite this, hospital-based data remain a powerful tool to study injuries in low and middle-income countries

Pediatric burn injuries in South Africa: A 15-year analysis of hospital data

Introduction: Burns are a significant burden of pediatric injuries, particularly in low and middle-income countries, were more than 90% of burn-related pediatric deaths occur. This study explores pediatric burn-related injuries over a fifteen year time period in South Africa through an analysis of a pediatric trauma surveillance system. Methods: This retrospective observational study used data collected by Childsafe South Africa from the Red Cross War Memorial Children\u27s Hospital (RCH) trauma registry in Cape Town, South Africa between 1995 and 2009 for children less than 13 years of age who presented with burn injuries to the hospital\u27s casualty department. Demographic data and Abbreviated Injury Scores (AISs) were first assessed, followed by an analysis of time trends using Poisson regression. Logistic regression models were used to analyse factors related to hospital admissions. Results: Between 1995 and 2009, 9438 children with burn-related injuries presented to RCH, of which nearly three-quarters resulted from scalds (73%; n = 7024). The mean age of the injured children was 3.1 ± 2.9 years 58% were male. 11 deaths occurred in the hospital\u27s casualty department. 39% of injuries were minor, 56% were moderate, and 5% were severe. During the 15-year study period, moderate burn injuries increased by 3%, while minor injuries decreased by 10% (p \u3c 0.05). 49% of all children were admitted to the hospital. Hospital admissions increased by 3% (p \u3c 0.05) during the study period. Conclusions: Pediatric burn injuries are a significant contributor to the burden of child diseases in developing county hospitals. Pediatric surveillance systems, such as Childsafe South Africa\u27s, are important to study epidemiologic changes in burn injuries. Findings suggest the need for targeted interventions to address the prevention of specific burn-related injuries. © 2013 Published by Elsevier Ltd