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      Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage

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          Abstract

          Background

          Road traffic injuries (RTIs) are a cause of significant morbidity and mortality in low- and middle-income countries. Access to timely emergency services is needed to decrease the morbidity and mortality of RTIs and other traumatic injuries. Our objective was to describe the distribution of roadtrafficcrashes (RTCs) in Nairobi with the relative distance and travel times for victims of RTCs to health facilities with trauma surgical capabilities.

          Methods

          RTCs in Nairobi County were recorded by the Ma3route app from May 2015 to October 2015 with latitude and longitude coordinates for each RTC extracted using geocoding. Health facility administrators were interviewed to determine surgical capacity of their facilities. RTCs and health facilities were plotted on maps using ArcGIS. Distances and travel times between RTCs and health facilities were determined using the Google Maps Distance Matrix API.

          Results

          89 percent (25/28) of health facilities meeting inclusion criteria were evaluated. Overall, health facilities were well equipped for trauma surgery with 96% meeting WHO Minimal Safety Criteria. 76 percent of facilities performed greater than 12 of three pre-selected ‘Bellweather Procedures’ shown to correlate with surgical capability. The average travel time and distance from RTCs to the nearest health facilities surveyed were 7 min and 3.4 km, respectively. This increased to 18 min and 9.6 km if all RTC victims were transported to Kenyatta National Hospital (KNH).

          Conclusion

          Almost all hospitals surveyed in the present study have the ability to care for trauma patients. Treating patients directly at these facilities would decrease travel time compared with transfer to KNH. Nairobi County could benefit from formally coordinating the triage of trauma patients to more facilities to decrease travel time and potentially improve patient outcomes.

          Level of evidence

          III

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          Most cited references12

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          Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia.

          Micaela M Esquivel, Tarsicio Uribe-Leitz, Emmanuel Makasa … (2016)
          Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making.
          Article 0 comments Cited 31 times – based on 0 reviews     Review now
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            Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey

            James Kimani, Remare Ettarh, Catherine Kyobutungi … (2012)
            Background The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. Methods The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Results Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. Conclusions The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.
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              Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures

              Barclay T Stewart, Gavin Tansley, Adam Gyedu … (2016)
              Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Trauma Surg Acute Care Open
                Journal ID (iso-abbrev): Trauma Surg Acute Care Open
                Journal ID (hwp): tsaco
                Journal ID (publisher-id): tsaco
                Title: Trauma Surgery & Acute Care Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2397-5776
                Publication date Collection: 2017
                Publication date (Electronic): 7 December 2017
                Volume: 2
                Issue: 1
                Electronic Location Identifier: e000130
                Affiliations
                [1 ]departmentSchool of Medicine , University of California , San Francisco, California, USA
                [2 ]departmentAccident and Emergency Department , Kenyatta National Hospital , Nairobi, Kenya
                [3 ]departmentDepartment of Pediatrics , Kenyatta National Hospital , Nairobi, Kenya
                [4 ]departmentDepartment of Surgery, Center for Global Surgical Studies , University of California , San Francisco, California, USA
                [5 ]departmentDepartment of Critical Care , Kenyatta National Hospital , Nairobi, Kenya
                Author notes
                [Correspondence to ] Dr Catherine Juillard, Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco 94110, California, USA; Catherine.Juillard@ 123456ucsf.edu
                Author information
                http://orcid.org/0000-0002-9635-7447
                Article
                Publisher ID: tsaco-2017-000130
                DOI: 10.1136/tsaco-2017-000130
                PMC ID: 5887833
                PubMed ID: 29766119
                SO-VID: d764abc2-1424-41f5-8d99-f3f10e78e0ec
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 22 September 2017
                Date revision received : 04 November 2017
                Date accepted : 07 November 2017
                Categories
                Subject: Original Article
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: global surgery,trauma systems,motor vehicle trauma
                Data availability:
                Keywords: global surgery, trauma systems, motor vehicle trauma

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