title: Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?
abstract: BACKGROUND
  This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load.
  
  
  METHODS
  Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care.
  
  
  RESULTS
  The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care.
  
  
  CONCLUSIONS
  There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and deliver all acute trauma patients to large regional trauma centers. If the first option is chosen, urgent intervention is required to build up the human resource capacity of district hospitals.
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa. damianclar@gmail.com.
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Aldous
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag 7, Congella, Durban, 4013, South Africa.|Division of Gastroenterology, E23 GI Unit, Groote Schuur Hospital, University of Cape Town, Room 93, New Main Building, Observatory, Cape Town, 7925, South Africa.
authors.forename: S R
authors.initials: SR
authors.lastname: Thomson
keywords: Acute trauma; Burden of disesease; District hospitals; Global surgery; Rural health; Surgcial capacity
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