title: How useful are Primary Trauma Care courses in sub-Saharan Africa?
abstract: BACKGROUND
  More than five million deaths occur each year from injury with the vast majority occurring in low and middle-income countries (LMICs). Africa bears the highest road traffic related mortality rates in the world. Despite this, formal training in trauma management is not widely adopted in these countries. We report our results of 10 consecutive Primary Trauma Care (PTC) courses delivered in seven East and Central African countries, as part of the COSECSA Oxford Orthopaedic Link (COOL) initiative.
  
  
  METHODS
  Candidate's knowledge and clinical confidence in trauma management were assessed using a multiple-choice questionnaire and a confidence matrix rating of eight clinical scenarios. We performed descriptive statistical analysis on knowledge and clinical confidence scores of candidates before and after the course. We sub-analysed these scores, examining specifically the difference that exist between gender, job-roles and instructors versus non-instructors.
  
  
  RESULTS
  We have trained 345 new PTC providers and 99 new PTC instructors over the 10 courses. Data sets were complete for 322 candidates. Just under a third of candidates were women (n=94). Over two-thirds of candidates (n=240) were doctors, while the remainder comprised of nurses, medical students and clinical officers. Overall, the median pre-course MCQ score was 70% which increased to 87% post course (p<0.05). Men achieved a higher MCQ score both pre- and post-course compared to women (p<0.05); however there was no significant difference in the degree of improvement of MCQ scores between gender. Instructors outperform non-instructors (p<0.05), and similarly doctors outperform non-doctors on final MCQ scores (post-course). However, it was the non-doctors who showed a statistically significant improvement in scores before and after the course (20% non-doctors vs 16% doctors, p<0.05). Candidate's clinical confidence also demonstrated significant improvement following the course (p<0.05).
  
  
  CONCLUSIONS
  Our work demonstrates that COOL-funded PTC courses in the COSECSA region delivered to front-line health staff have helped improve their knowledge and confidence in trauma management, irrespective of their job-roles and gender. Further follow-up is needed to establish the long-term impact of PTC courses in this region.
authors.affiliation: Royal Berkshire Hospital, NHS Foundation Trust, Reading, UK. Electronic address: nogaro.mc@gmail.com.
authors.forename: Marie-Caroline
authors.initials: MC
authors.lastname: Nogaro
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK. Electronic address: hemant.pandit@ndorms.ox.ac.uk.
authors.forename: Hemant
authors.initials: H
authors.lastname: Pandit
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK. Electronic address: noel.peter@ndorms.ox.ac.uk.
authors.forename: Noel
authors.initials: N
authors.lastname: Peter
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK. Electronic address: grace.le@ndorms.ox.ac.uk.
authors.forename: Grace
authors.initials: G
authors.lastname: Le
authors.affiliation: Bedford Orthopaedic Centre, Nelson Mandela Academic Hospital Complex, Mthatha, South Africa. Electronic address: davyin04@yahoo.co.uk.
authors.forename: David
authors.initials: D
authors.lastname: Oloruntoba
authors.affiliation: University of Zimbabwe, Harare, Zimbabwe. Electronic address: godfreymuguti@yahoo.co.uk.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Muguti
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospital NHS Trust, Oxford, UK. Electronic address: christopher.lavy@ndorms.ox.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lavy
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001291:Attitude of Health Personnel; D002568:Certification; D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014194:Traumatology / Q000193:education*
keywords: Courses; Developing countries; Trauma