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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
First things first: Effectiveness and scalability of a basis prehospital trauma care program for lay first-responders in Kampala, Uganda
PLoS ONE, Volume 4, No. 9, Article e6955, Year 2009
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Description
Background: We previously showed that in the absence of a formal emergency system, lay people face a heavy burden of injuries in Kampala, Uganda, and we demonstrated the feasibility of a basic prehospital trauma course for lay people. This study tests the effectiveness of this course and estimates the costs and cost-effectiveness of scaling up this training. Methods and Findings: For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program. At six months, 188 (62%) of the trainees were followed up. Their knowledge retention remained high or increased. The mean correct score on a basic fund of knowledge test was 92%, up from 86% after initial training (n = 146 pairs, p = 0.0016). 97% of participants had used at least one skill from the course: most commonly haemorrhage control, recovery position and lifting/moving and 96% had used at least one first-aid item. Lack of knowledge was less of a barrier and trainees were significantly more confident in providing first-aid. Based on cost estimates from the World Health Organization, local injury data, and modelling from previous studies, the projected cost of scaling up this program was $0.12 per capita or $25-75 per life year saved. Key limitations of the study include small sample size, possible reporter bias, preliminary local validation of study instruments, and an indirect estimate of mortality reduction. Conclusions: Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries. © 2009 Jayaraman et al.
Authors & Co-Authors
Jayaraman, Sudha P.
United States, San Francisco
University of California, San Francisco
Mabweijano, Jacqueline R.
Uganda, Kampala
Makerere University
Lipnick, Michael S.
United States, Boston
Brigham and Women's Hospital
Cadwell, Nolan
United States, San Francisco
Ucsf School of Medicine
Miyamoto, Justin
United States, San Francisco
Ucsf School of Medicine
Wangoda, Robert
Uganda, Kampala
Makerere University
Mijumbi, Cephas
Uganda, Kampala
Makerere University
Hsia, Renee Yuen Jan
United States, San Francisco
University of California, San Francisco
Dicker, Rochelle Ami
United States, San Francisco
San Francisco General Hospital and Trauma Center
Ozgediz, Doruk Erman
Canada, Toronto
Hospital for Sick Children University of Toronto
Statistics
Citations: 166
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0006955
e-ISSN:
19326203
Research Areas
Violence And Injury
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Uganda