JMIR Publications

ABSTRACT

Background:

Injury-related mortality exhibits a significant social gradient globally. This poses a threat to the achievement of inclusive health and well-being, congruent with Sustainable Development Goal (SDG3). Despite improvements in the quality of medical education (SDG4), a paucity of studies has positioned medical trainees as patients’ advocates to address health inequities at practice and policy levels.

Objective:

The objective of this study was to investigate the pre-hospital and in-hospital barriers to timely injury care as perceived by frontline trainee physicians and traffic law enforcement professionals in Uganda. Additionally, we aimed to identify the barriers encountered during real-time execution of treatment, and to highlight the potential impact of these barriers on injury outcomes.

Methods:

: We employed a convergent mixed methods approach. Qualitative data were collected through semi-structured questionnaires and face-to-face group interviews with diverse teams of five hundred frontline trainee physicians including surgical residents, interns, medical students, and traffic law enforcement professionals. The data were analyzed using directed content thematic analysis, facilitated by NVivo 14.0. Quantitative data were concurrently collected using a survey questionnaire from the motorcycle trauma outcome (MOTOR registry project) which included 1,003 trauma patients, analyzed using Stata 15.0. We categorized barriers into pre-hospital or in-hospital; and as trauma team-related, patient-related, or health system-related.

Results:

Qualitative analyses identified key pre-hospital barriers, including delays in emergency medical services activation, ambulance arrival, and transportation. In-hospital barriers were primarily shortage of supplies, delays in identifying life-threatening injuries, and insufficient critical care services. Quantitatively, among the 1,003 audited trauma patients, 42% (n=416) faced barriers during treatment, the most common being delays in treatment decisions (n=232, 23%), and securing necessary supplies (n=180, 18%). After adjusting for injury severity, the presence of barriers was associated with nearly twice higher odds of unfavorable Glasgow Outcome Scale scores (1-3) for neurological injuries [OR 1.750, 95% CI (1.497-2.047) vs. OR 0.556, 95% CI (0.436-0.708), p<0.001] and 90-day mortality [OR 1.901, 95% CI (1.057-3.420) vs. OR 0.588, 95% CI (0.397-0.869), p<0.001].

Conclusions:

These findings highlight the need for multifaceted targeted interventions, which integrate frontline health workers’ and trainee physicians’ perspectives to improve trauma care delivery in low-resource settings which face both pre-hospital and in-hospital barriers. Clinical Trial: Pan African Clinical Trial Registry PACTR202308851460352