Evaluation of trauma care resources in health centers and referral hospitals in Cambodia.
BACKGROUND
The aim of this study was to evaluate the available resources for trauma care at health centers (HCs) and referral hospitals (RHs) in rural Cambodia and to examine whether the resources at HCs are allocated on the basis of actual need based on the referral distance and number of severely injured patients referred to RHs.


METHODS
We conducted a cross-sectional facility survey by phone interview or mail using structured questionnaires at nationally representative samples of 85 HCs and 17 RHs from December 2006 to April 2007. The questionnaire included a modified checklist of the guidelines for essential trauma care as well as questions on distance for referral and the number of injured patients received and referred during the last 3 months. We analyzed the association between resource availability at HCs and their need using multivariate linear regression.


RESULTS
Median (interquartile range) numbers of available resources at HCs and RHs were 25.5 (22.0-27.5) and 35 (28-41) among 37 and 62 essential items, respectively. Basic equipment, including both consumable supplies and durable devices and life-saving knowledge/skills, were not satisfactory at either HCs or RHs. A longer distance to the RH was associated with more knowledge/skills but not with equipment supplies; the number of referred patients was not associated with equipment or knowledge/skills.


CONCLUSIONS
Staff training emphasizing life-saving knowledge/skills and better organization and planning to supply physical resources are needed. There is a gap between resource allocation and need, which should be addressed through clear policies to prioritize remote areas and to allocate resources based on reliable injury data.
Nakahara
Shinji
S
Department of Preventive Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan. snakahara@marianna-u.ac.jp
Saint
Saly
S
Sann
Sary
S
Phy
Radian
R
Ichikawa
Masao
M
Kimura
Akio
A
Eng
Lycheng
L
Yoshida
Katsumi
K
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002160:Cambodia; D003430:Cross-Sectional Studies; D006291:Health Policy; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D040841:Resource Allocation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014194:Traumatology / Q000458:organization & administration; D014947:Wounds and Injuries / Q000628:therapy*