Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi

作者：John Whitaker, Idara Edem, Ella Togun, Abena S. Amoah, Albert Dube, Lindani Chirwa, Boston Munthali, Giulia Brunelli, Thomas P. Van Boeckel, Rory Rickard, Andrew Leather, Justine Davies · 发表于：PLoS Medicine · 年份：2024 · DOI：10.1371/journal.pmed.1004344 · 被引用次数：7 · 研究领域：Trauma and Emergency Care Studies、Injury Epidemiology and Prevention、Global Health and Surgery

BACKGROUND: Injuries represent a vast and relatively neglected burden of disease affecting low- and middle-income countries (LMICs). While many health systems underperform in treating injured patients, most assessments have not considered the whole system. We integrated findings from 9 methods using a 3 delays approach (delays in seeking, reaching, or receiving care) to prioritise important trauma care health system barriers in Karonga, Northern Malawi, and exemplify a holistic health system assessment approach applicable in comparable settings. METHODS AND FINDINGS: To provide multiple perspectives on each conceptual delay and include data from community-based and facility-based sources, we used 9 methods to examine the injury care health system. The methods were (1) household survey; (2) verbal autopsy analysis; (3) community focus group discussions (FGDs); (4) community photovoice; (5) facility care-pathway process mapping and elucidation of barriers following injury; (6) facility healthcare worker survey; (7) facility assessment survey; (8) clinical vignettes for care process quality assessment of facility-based healthcare workers; and (9) geographic information system (GIS) analysis. Empirical data collection took place in Karonga, Northern Malawi, between July 2019 and February 2020. We used a convergent parallel study design concurrently conducting all data collection before subsequently integrating results for interpretation. For each delay, a matrix was created to ju...