title: The orthopaedic trauma patient experience: a qualitative case study of orthopaedic trauma patients in Uganda.
abstract: The disability adjusted life years (DALYs) associated with injuries have increased by 34% from 1990 to 2010, making it the 10th leading cause of disability worldwide, with most of the burden affecting low-income countries. Although disability from injuries is often preventable, limited access to essential surgical services contributes to these increasing DALY rates. Similar to many other low- and middle-income countries (LMIC), Uganda is plagued by a growing volume of traumatic injuries. The aim of this study is to explore the orthopaedic trauma patient's experience in accessing medical care in Uganda and what affects the injury might have on the socioeconomic status for the patient and their dependents. We also evaluate the factors that impact an individual's ability to access an appropriate treatment facility for their traumatic injury. Semi-structured interviews were conducted with patients 18 year of age or older admitted with a fractured tibia or femur at Mulago National Referral Hospital in Kampala, Uganda. As limited literature exists on the socioeconomic impacts of disability from trauma, we designed a descriptive qualitative case study, using thematic analysis, to extract unique information for which little has been previously been documented. This methodology is subject to less bias than other qualitative methods as it imposes fewer preconceptions. Data analysis of the patient interviews (n = 35) produced over one hundred codes, nine sub-themes and three overarching themes. The three overarching categories revealed by the data were: 1) the importance of social supports; 2) the impact of and on economic resources; and 3) navigating the healthcare system. Limited resources to fund the treatment of orthopaedic trauma patients in Uganda leads to reliance of patients on their friends, family, and hospital connections, and a tremendous economic burden that falls on the patient and their dependents.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nathan N
authors.initials: NN
authors.lastname: O'Hara
authors.affiliation: Department of Orthopaedics, Makerere University, Kampala, Uganda.
authors.forename: Rodney
authors.initials: R
authors.lastname: Mugarura
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
authors.affiliation: Department of Orthopaedics, Seattle Children's Hospital, Seattle, Washington, United States of America.
authors.forename: Maryse
authors.initials: M
authors.lastname: Bouchard
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000191:economics*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics*; D036301:Qualitative Research; D019057:Quality-Adjusted Life Years; D012959:Socioeconomic Factors; D013978:Tibial Fractures / Q000191:economics*; D014454:Uganda; D055815:Young Adult