Aldina Mesic, MPH, PhD(c)

Nominated From: University of Washington

Research Site: Kwame Nkrumah University of Science and Technology

Research Area: Injury and Road Safety

Primary Mentors: Dr. Barclay Stewart and Dr. Adam Gyedu

Research Project

Collaboration to inform Road safety intervention and hazard reduction in Ghana (CRASH Ghana)

The burden of road traffic injuries (RTIs) and deaths is disproportionately high in Ghana and other low- and middle-income countries (LMICs). Despite efforts to improve emergency care and to expand access to prehospital care, there are major access inequities to post-crash care, resulting in preventable death and disability. Given the systematic collection of comprehensive road crash data nationally since 2003, there are opportunities to utilize advanced geospatial analyses to link RTIs with prehospital care (i.e., stabilization points, ambulance bases), and trauma care-capable centers. This proposal will address this research gap in strategic allocation of prehospital trauma care by pursing three specific aims: 1) to use advanced geospatial methods to link crash, RTI, and death hotspots with ambulatory bases, stabilization points, and trauma care-capable health facilities; 2) to conduct a 9-month prospective observational study in select trauma care-capable health facilities with patients experiencing RTIs to understand experiences and implementation of pre-hospital care 3) to conduct in-depth qualitative interviews with patients, providers at trauma care-capable health facilities, and the ambulatory service to determine barriers and facilitators to seeking, receiving, and implementing high quality pre-hospital care.

Research Significance

Prehospital care has consistently been shown to significantly reduce mortality after trauma particularly during the intermediate or subacute phase. Effective prehospital care depends on availability of services (e.g., first responders in the community, trained emergency service technicians, ambulances) and the locations of crashes and associated injuries to ambulance bases and trauma care-capable centers (i.e., regional, and tertiary hospitals capable of definitive trauma care). Given the importance of location, there is a need to understand geographical distributions of RTIs and distances to trauma care-capable centers in Ghana to effectively utilize existing services and plan future expansions. Specifically, hot spots of RTIs should be linked with trauma care-capable centers to identify gaps where there is high demand. This is well aligned with Ghana’s current ‘Agenda 111’, which aims to strategically build and improve 111 hospitals and equip them with trauma services in 5 years. Additionally, geospatial analyses can allow for the NAS to strategically plan ambulance bases and stabilization points (district hospitals with additional post-crash care training). With strategic allocation, there will be fewer delays in first response and in transport, both key periods associated with both higher survival and lower disability after trauma. Efforts to improve prehospital care are well-aligned with the WHO’s Road Safety Targets, one of which states “by 2030, all countries establish and achieve national targets in order to minimize the time interval between road traffic crash and the provision of first professional emergency care.” Beyond geospatial analyses, we are proposing to collect quantitative and qualitative with patients admitted with RTIs to understand experiences and implementation of prehospital care. The proposed work will contribute directly to the efforts to meet road safety targets in the next decade.


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