Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma.

Abstract

Assessment of the societal importance of trauma relies, in large part, on hospital and other health service data. Such data are of limited value in developing nations if a significant proportion of injured persons do not receive formal medical care. We undertook an epidemiologic study of trauma in Ghana. Via household visits, we surveyed 21,105 persons living in 432 urban and rural sites. During the preceding year, there had been 13 fatal injuries (62 per 100,000) and 1,597 nonfatal injuries resulting in > or = 1 days of lost activity (7 per 100). Of the fatally injured, only 31% received formal medical care (hospital or clinic). Of the nonfatal injuries, 58% received formal care, but with major differences between urban and rural sites. Only 51% of rural injured received formal medical care, compared with 68% of urban injured (p < 0.001). Even among those with more severe injuries (disability time > or = 1 month), 26% of rural injured never had formal care. Overall hospital use was especially low, with only 27% of all injured persons using hospital services. Among those with more severe injuries, 60% of urban, but only 38% of rural injured received hospital care (p < 0.001). These data indicate low utilization of formal medical services by injured persons in this developing nation. Even many of those with severe injuries do not receive medical care, especially in rural areas. Assumptions that rely on health service data, especially hospital data, underestimate the importance of trauma. Appropriate commitment of health care resources might thus be affected. Population based data are needed to fully assess the extent and societal impact of injuries in developing nations.