title: Trauma systems in Kenya: a qualitative analysis at the district level.
abstract: 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.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Hadley K H
authors.initials: HK
authors.lastname: Wesson
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Johns Hopkins Medical Institutions, Baltimore, Maryland, USA ksteve14@jhmi.edu.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: Roless Media Management Institute, Nairobi, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mogere
authors.affiliation: Kenyatta University, Nairobi, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Akungah
authors.affiliation: Kenyatta University, Nairobi, Kenya.
authors.forename: Jackim
authors.initials: J
authors.lastname: Nyamari
authors.affiliation: Ministry of Medical Services, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Masasabi Wekesa
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000056:Accident Prevention; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012424:Rural Population; D014505:Urban Population; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
keywords: Africa, sub-Saharan; health care, access to; health seeking; research, qualitative; trauma