Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

Background The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering bar...

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Main Authors: Andrew J M Leather, Dan Poenaru, Max Denning, John Whitaker, Nollaig O'Donohoe, Elena Guadagno
Format: Article
Language:English
Published: BMJ Publishing Group 2021-05-01
Series:BMJ Global Health
Online Access:https://gh.bmj.com/content/6/5/e004324.full
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spelling doaj-57884e18e3f74c98ac65f1763fe19f8e2021-06-26T09:30:25ZengBMJ Publishing GroupBMJ Global Health2059-79082021-05-016510.1136/bmjgh-2020-004324Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessmentsAndrew J M Leather0Dan Poenaru1Max Denning2John Whitaker3Nollaig O'Donohoe4Elena Guadagno5King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UKHarvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, CanadaDepartment of Surgery and Cancer, Imperial College London, London, UKKing's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UKDepartment of Colorectal Surgery, King's College London, London, UKHarvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, CanadaBackground The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.Methods We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.Results Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.Conclusions Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.https://gh.bmj.com/content/6/5/e004324.full
collection DOAJ
language English
format Article
sources DOAJ
author Andrew J M Leather
Dan Poenaru
Max Denning
John Whitaker
Nollaig O'Donohoe
Elena Guadagno
spellingShingle Andrew J M Leather
Dan Poenaru
Max Denning
John Whitaker
Nollaig O'Donohoe
Elena Guadagno
Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
BMJ Global Health
author_facet Andrew J M Leather
Dan Poenaru
Max Denning
John Whitaker
Nollaig O'Donohoe
Elena Guadagno
author_sort Andrew J M Leather
title Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
title_short Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
title_full Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
title_fullStr Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
title_full_unstemmed Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
title_sort assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the three delays framework to injury health system assessments
publisher BMJ Publishing Group
series BMJ Global Health
issn 2059-7908
publishDate 2021-05-01
description Background The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.Methods We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.Results Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.Conclusions Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
url https://gh.bmj.com/content/6/5/e004324.full
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