Barclay Stewart, MD MPH

Stewart, Barclay

Nominated From: University of Washington

Research Site: Ghana

Research Area: Trauma

Primary Mentor: Charlie Mock

Research Project

Assessment of the availability and sustainability of physical resources in the care of the injured patient in Ghana

Reasons for increased disability and mortality rates for injuries in LMICs include lack of personnel, both in numbers and level of training, and insufficient organization and planning of pre-hospital and hospital care in most low- and middle-income countries (LMICs). Another important and overlooked element in preventing disability and death from injury is lack of equipment necessary to provide quality trauma care; many technology-related. Trauma care requires a wide array of technology, including diagnostic (e.g. radiology and laboratory tests) and therapeutic (e.g. equipment to open obstructed airways or to set fractured bones). Better definition of and more reliable availability of such technology has been a major component of improving trauma care in high-income countries. Similar attention to assuring necessary and appropriate technology is needed in LMICs.

The WHO developed the Guidelines for Essential Trauma Care to improve organization and planning for trauma care globally. These Guidelines define the minimum essential resources for trauma care, delineating 260 items of human and physical resources that should be present in the spectrum of health care facilities providing care to trauma patients. These include 80 technology-related items, ranging from low-cost equipment for airway maintenance, to more expensive and complex items such as computed tomography scanners. The WHO Guidelines have been used as the basis for needs assessments in several countries where significant deficiency in essential technology resources have been noted. This proposed project will assess availability of the technology-related resources in Ghana.

Specific Aims:

1. Identify deficiencies in the availability of essential trauma care technology as defined by the World Health Organization’s Guidelines for Essential Trauma Care in representative health care facilities in Ghana.
2. Define specific problems leading to these deficiencies, such as cost, procurement, stocking, and maintenance.
3. Identify potential solutions to the above deficiencies in terms of two broad categories, health system management (such as improved procurement practices) and engineering (such as improved design to decrease cost, increase durability, and facilitate maintenance).

The status of 80 technology-related items of equipment and supplies will be assessed at selected health care facilities, ranging from rural clinics to tertiary care centers. This study will obtain data to describe and improve the management of the essential equipment and technology involved in trauma care, potentially aid in important product development, and ultimately contribute to a lowered burden of death and disability from injury globally.


Research Significance

Injuries from road traffic crashes, violence, and other causes result in 5.8 million deaths per year – which is more than the number of deaths from HIV/AIDS, TB, and malaria combined. Millions more people are left with temporary or permanent disabilities from injury. The vast majority (90%) of these deaths are in LMICs. Within any country, it is usually the poorest and most vulnerable members of society who are exposed to unsafe or violent conditions and get injured. These are also the people least able to afford quality medical care, and are most often the ones left with disabilities from injury, creating an ongoing cycle of poverty. Despite the enormous and growing burden of traumatic disease and death, injuries are neglected by governments and funders. As just one measure of this neglect, injuries are estimated to account for 12% of the global burden of death and disability, yet the World Health Organization (WHO) devotes less than 1% of its budget to addressing this epidemic. Reducing the burden of disease from injury requires a systematic approach including injury prevention, pre-hospital and hospital trauma care, and rehabilitation. There are considerable discrepancies in outcome for injured persons in high-income countries and LMICs. Persons with life-threatening but treatable injuries are up to six times more likely to die in LMICs than in high-income countries. It has been estimated that reducing such disparities through improved trauma care in LMICs could save the lives of up to 2 million out of the 5.8 million people who die from injury each year.

The results of this strategic overview will provide firm evidence for the need for the development of several specific products. This will in turn provide a strengthened basis for funding applications to organizations such as WGHTP and the NIH noted above, as both funders were more interested in specific product development. Many of these items of technology will have direct commercial applications, such as equipment that has been engineered to overcome the obstacles identified in the study through features such as improved durability, decreased cost, and improved ease of user interface. Ultimately, these refined technologies will improve the care of the injured and reduce morbidity and mortality globally.


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