The development of guidelines to improve the trauma care system in selected hospitals of Addis Ababa, Ethiopia

Abstract

Africa accounts for a third of the world’s 1.35 million annual road traffic fatalities, with Ethiopia bearing the continent's highest rate at 26.7 deaths per 100,000 residents. To address this challenge and meet the WHO SDG Target 3.6 of reducing traffic-related trauma and deaths, Ethiopia must strengthen its trauma care system and quality standards. The study aimed to develop guidelines to improve the trauma care system in Addis Ababa, Ethiopia. A sequential explanatory mixed methods design was used to evaluate the current state of the trauma care system in nine hospitals. In the quantitative phase, a checklist adapted from the World Health Organization (WHO) was used to assess emergency departments, and a structured, self-administered questionnaire was distributed to 422 trauma team members to identify challenges in emergency trauma care. Additionally, the medical records of 333 patients were reviewed through structured questionnaires to assess the continuum of trauma care. The qualitative phase involved in-depth interviews with 23 participants and five focus group discussions, each consisting of 3 to 4 individuals. Quantitative data analysis included descriptive statistics and binary logistic regression, while Colaizzi’s seven-step process guided the qualitative data analysis. The study revealed several challenges within the trauma care system. Although all hospitals had triage corridors, only 77.8% followed national emergency preparedness policies, and just 55.5% had sufficient infrastructure. More than half of the trauma team members were unaware of specific guidelines. While 65% of essential supplies for trauma care were available, airway equipment was present in only 47.7% of cases. Power and water outages were frequent, 44.4% of emergency departments lacked security, and 66.7% of hospitals did not offer prehospital care or patient handover processes. The qualitative findings identified five key themes: Basics of the trauma care system, prehospital trauma care service, preparedness, coordination, and continuum of trauma care, competency of trauma team members and perception of a trauma team member. Based on these study findings insights, guidelines were developed to improve the quality of the trauma care system in Addis Ababa.