title: Assessing trauma care at the district and provincial hospital levels: a case study of hospitals in Kenya.
abstract: 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's 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.
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA; Department of Surgery, Virginia Commonwealth University Medical Center, 1200 E. Broad Street, Richmond, VA 23219, USA.
authors.forename: Hadley K H
authors.initials: HK
authors.lastname: Wesson
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: Ministry of Health, Afya House, Cathedral Road, P.O. Box 30016-00100, Nairobi, Kenya.
authors.forename: John Masasabi
authors.initials: JM
authors.lastname: Wekesa
authors.affiliation: Naivasha District Hospital, PO Box 141, Naivasha, Kenya.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mburu
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA; Department of Surgery, Johns Hopkins University, 720 Rutland Ave, Baltimore, MD 21205, USA. Electronic address: ksteve14@jhmi.edu.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
mesh_terms: D057189:Checklist; D006301:Health Services Needs and Demand; D006766:Hospitals, County / Q000592:standards; D006767:Hospitals, District / Q000592:standards; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D058996:Quality Improvement; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014193:Trauma Centers / Q000191:economics / Q000592:standards; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology / Q000628:therapy*
keywords: Developing countries; Low and middle income countries; Trauma care