Training Traditional Bonesetters in Basic Principles of Fracture Treatment: A Proof of Concept in Ghana.

BACKGROUND: Our study assessed the effectiveness of a traditional bonesetter (TBS) educational program that was designed to increase knowledge, reduce complications, and promote the referral of patients to local hospitals by TBSs when necessary. METHODS: From April to December 2021, TBSs from the Northern Sector (the Northern, Savannah, and North East regions) and the Ashanti region of Ghana underwent a 4-day training course that had been designed to teach basic principles of fracture care with the use of local tools. We assessed the levels of knowledge of the TBSs both before and after training. The change in practice of the trained TBSs also was assessed at 6 months using a structured questionnaire and a checklist. RESULTS: In total, 157 TBSs were trained in 5 training sessions over a 9-month period. There was an improvement in knowledge in all of the modules of training, with an overall knowledge gain of 19.7% (from 67.2% to 86.9%). At 6 months of follow-up, the practices of TBSs that had most improved were record-keeping, hand hygiene, and patient rehabilitation. As a result of the referral system that was established by the training project, a total of 37 patients were referred to local hospitals in the 6 months following the training. CONCLUSIONS: Formal training for TBSs that was provided by a multidisciplinary team with use of a locally developed curriculum and tools was effective in improving the practice and outcomes of treatment by TBSs. There was marked knowledge retention by the trained TBSs at 6 months after training in fracture management. CLINICAL RELEVANCE: Education, training, and the establishment of referral pathways between TBSs and local hospitals could improve trauma care in Ghana.

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review.

Purpose of Review: Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings: A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager's four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public-private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary: Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action. Supplementary Information: The online version contains supplementary material available at 10.1007/s40719-022-00229-1.

Rising Trend of "Veil Entanglement Injuries" in Northern Ghana: A Case Series.

INTRODUCTION: Veils are thin garments that are worn over the head, wrapped round the neck, and left hanging loosely over the torso up to the thighs. They are also known as scarf or "dupatta." Veils can get entangled in spokes of motorbikes or in belt-driven machinery resulting in a variety of life-threating injuries. CASE REPORTS: We report nine major cases of veil entanglement injuries (VEI) that presented to the Orthopedic Unit of Tamale Teaching Hospital from July 10, 2017 to June 12, 2020. All the patients were females with ages ranging from 5-months to 44-year. All the accidents involved either a motorbike or auto rickshaw. Head, neck, and extremity injuries were the most common. Eight out of nine patients had circumferential neck bruise referred to as "veil sign" in this report. One patient died. CONCLUSION: The rising trend of VEI is alarming among women in Northern Ghana. We recommend widespread public education and awareness creation. We also recommend modification of traffic regulations by policy makers to avert this avoidable injury.

Factors affecting utilization of traditional bonesetters in the Northern Region of Ghana.

BACKGROUND: Traditional bonesetters (TBS) are still highly patronized by people with fractures in Africa. We sought to investigate factors affecting the utilization of TBS services in the Northern Region of Ghana. METHODS: A mixed-methods study that combined both qualitative and quantitative approaches was conducted among 64 TBS clients in the Northern Region of Ghana. Participants were purposively selected and should have utilized the services of TBSs at the time of the study. In addition, three focus group discussions (FGDs) were conducted to complement the quantitative results. Quantitative analysis was performed by calculating means and proportions. For the qualitative data, content analysis was done manually based on emerging themes in line with the study objectives. RESULTS: Sixty-four (64) clients were recruited. Twenty-four (37.5%) were female. The modal age group was 19-39 years. The educational status of the clients was dominated by primary/junior secondary education (39.1%), but included the full spectrum from no formal education / illiterate (26.6%) to tertiary (12.5%). Cheaper fees (26.3%), cultural beliefs (17.9%), and quick service (15.9%) were the main reason of patronizing TBSs. Twenty-two (34.3%) would have preferred orthodox care and the reasons cited included availability of X-rays (27.3%) and pain management (25.3%). These themes were reiterated by FGDs with an additional 30 clients. Additional themes identified by the FGDs included a belief that TBSs address both physical and spiritual aspects of the injury and the major role that families (not the injured person alone) make in deciding on type of treatment. Clients were supportive of orthodox providers linking with TBSs for activities such as training to improve pain control. CONCLUSION: TBSs have patronage from the full spectrum of society. The decision to opt for TBS treatment was influenced by cheaper fees, cultural belief, and quick service. TBS clients wanted greater linkages between TBSs and orthodox providers.

Traditional bonesetters in northern Ghana: opportunities for engagement with the formal health sector.

INTRODUCTION: we sought to explore the knowledge and practices among traditional bonesetters (TBSs) in the Northern Region of Ghana and to assess opportunities for their engagement with the formal health sector. METHODS: we identified 28 TBSs widely distributed in the Northern Region. They were interviewed using qualitative and quantitative methods, regarding their background, training, current practices, opinions regarding orthodox care, and interests in future linkages with the formal health sector. RESULTS: most TBSs (67.9%) had no formal education and most (85.7%) learned their skills from older family members. Their treatments included reasonable versions of closed reduction and immobilization, but also use of locally-derived concoctions and spiritual aspects, such as incantations. Only 21.4% regularly referred complications to hospital. Nonetheless, all endorsed advantages to orthodox care, such as X-rays (100%), record keeping (100%), and pain management (85.7%). Almost all (96.4%) expressed an interest in training courses or other engagement with the formal health sector. Topics in which they were interested for training included record keeping (100%), pain management (85.7%), and management of open fractures and complications (82.1%). CONCLUSION: factors making linkage between TBSs and the formal health sector difficult included low levels of formal education, training through secretive in-family methods, and spiritual and mystical aspects of their practice that might make communications about modern medicine difficult. Nonetheless, most indicated interest in linking with modern care, especially through training courses. Topics they suggested for such courses provide a foundation to build on in future efforts to engage TBSs with the formal health sector.

Premorbid risk perception, lifestyle, adherence and coping strategies of people with diabetes mellitus: A phenomenological study in the Brong Ahafo Region of Ghana.

BACKGROUND: One of the non-communicable diseases which is on the rise is type 2 diabetes (T2D). T2D is largely preventable with healthy lifestyle. We therefore conducted this study to explore premorbid perception of risk, behavioural practices and the coping strategies of patients with T2D. METHODS: Using descriptive phenomenology approach to qualitative enquiry, we conducted eight focus group discussions (N = 73) with diabetic patients; four among males (N = 36) and four among females (N = 37). In addition, we conducted in-depth interviews with 15 patients, seven caretakers and three physicians. We adopted Colaizzi's descriptive phenomenology approach to analyse the data with the aid of NVivo 11. RESULTS: We found that respondents believed diabetes was a condition for the aged and rich and this served as a premorbid risk attenuator. Majority of them engaged in diabetes-related high risk behaviours such as lack of exercise, sedentary lifestyle and unhealthy eating despite their foreknowledge about the role of lifestyle in diabetes pathogenesis. We also found that patients used moringa, noni, prekese, and garlic concurrently with orthodox medications. Adherence to dietary changes and exercises was a challenge with females reporting better adherence than males. The study also revealed that patients believed biomedical health facilities paid little attention to psychosocial aspects of care despite its essential role in coping with the condition. CONCLUSION: Diabetic patients had low premorbid perception of risk and engaged in diabetes-related risky behaviours. Diabetic patients had challenges adhering to lifestyle changes and use both biomedical and local remedies in the management of the condition. Psychosocial support is necessary to enhance coping with the condition.