Injury care in low- and middle-income countries: identifying potential for change

Abstract

The epidemiologic, demographic, and socio-political transitions underway in many low- and middle-income countries (LMIC) are associated with a substantial burden of disease due to injuries. LMIC have devoted relatively little attention to the injury problem. This paper argues that whereas prevention remains paramount, improving health care services for injuries will also contribute to reducing the burden. It examines the reasons for the relative inaction in LMIC to date, and contrasts this to high-income countries (HIC) which have seen substantial falls in mortality from improved trauma care systems. Mortality data, although readily available, are the tip of the clinical iceberg and there is a need for better-quality hospital data that can be used to monitor any future improvements. Models of trauma care from HIC are reviewed. It is suggested that the greatest potential for improvement can be achieved if entire trauma systems are improved, including pre-hospital, hospital and rehabilitation care. LMIC may not be able to afford the whole system and improving the most sensitive components of the system may be a better option. Models of trauma care developed in HIC need careful consideration to determine their effectiveness, appropriateness, affordability and equity implications for LMIC. Imports of blueprints from elsewhere are likely to fail; context sensitive and appropriate policies need to be developed locally through a consultative process. Effective working needs to be across disciplines, involving consultation with stakeholders, and requires investment in education, training and equipment. The evidence base for trauma services in LMIC is almost non-existent, highlighting the urgent need for research in these settings.