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Open Access

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

Brian I Shaw, Ali Akida Wangara, Gladys Mbatha Wambua, Jason Kiruja, Rochelle A Dicker, Judith Mutindi Mweu, Catherine Juillard
DOI: 10.1136/tsaco-2017-000130 Published 7 December 2017
Brian I Shaw
1School of Medicine, University of California, San Francisco, California, USA
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Ali Akida Wangara
2Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
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Gladys Mbatha Wambua
2Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
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Jason Kiruja
3Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
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Rochelle A Dicker
4Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California, USA
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Judith Mutindi Mweu
5Department of Critical Care, Kenyatta National Hospital, Nairobi, Kenya
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Catherine Juillard
4Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California, USA
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    Kernel density plot of road traffic crashes (RTCs) by hour of day.

  • Figure 2
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    Figure 2

    Geospatial distribution of road traffic incidents and health facilities in Nairobi, Kenya.

Tables

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  • Table 1

    Road traffic crash characteristics for Ma3route data collected between May 2015 and October 2015 (n=982)

    CharacteristicN (%)
    Vehicle involved
    Car382(39)
    Truck173(18)
    Bus/matatu266(27)
    Pedestrian92 (9.4)
    Motorcycle66 (6.7)
    Other20 (2.0)
    Unknown300(31)
    Attended by?
    Police93 (9.5)
    Ambulance24 (2.4)
    Fatality reported at scene53 (5.4)
  • Table 2

    Hospital staffing and operative capacity by facility type

    Facility type*All (n=25)Faith based (n=4)Private (n=17)Public (n=4)P ­value
    Anesthesia, Surgery, Ortho, Ob/Gyn On- Call—­N (%)21(84)3 (75)16(94)2 (50)P=0.083
    Anesthesia, Surgery, Ortho, Ob/Gyn 24/7—­­N (%)5 (20)1 (25)3 (17)1 (25)P=1.0
    Meets WHO Minimal Safety Criteria—­­N (%)24(96)4 (100)16(94)4 (100)P=1.0
    Perform >12 of three Index Operations—­N (%)19(76)3 (75)13(77)3 (75)P=1.0
    • *Faith-based facilities are those operated directly by religious organization. Private facilities are those operated by any private organization with varying levels of affiliation with the Ministry of Health. Public facilities are those operated directly by the Ministry of Health.

  • Table 3

    Per cent availability of equipment by facility type

    Facility typeAll (n=25) (%)Faith based (n=4) (%)Private (n=17) (%)Public (n=4) (%)*P ­ value
    Availability of Anesthesia Equipment—­Med (IQR)100 (100–­100)100 (95–­100)100 (100–­100)100 (100–­100)0.42
    Availability of Sterile Instruments—Med (IQR)100 (100-–100)100 (95–­100)100 (100–100)100 (100–­100)0.42
    Availability of CT Scanner Med(IQR)90 (0–100)90 (45–­95)90 (0–­100)50 (0–100)0.99
    Availability of Blood Products Med (IQR)70 (50–­100)75 (55–85)70 (50–­100)60 (45–­85)0.76
    • *All comparisons by Kruskal-­Wallis test.

  • Table 4

    Travel time to health facility under different conditions

    ConditionTime of transport 
    (Min)–­Med(IQR)
    P value*
    All health facilities7 (5–­12)Reference value
    Kenyatta National Hospital (KNH)only18 (13–­22)P<0.001
    KNH+114 (9–­19)P<0.001
    KNH+211(7–­15)P<0.001
    • *All comparisons by Kruskal-­Wallis with Dunn’s post test.

  • Table 5

    Distance to health facility under different conditions

    ConditionDistance (km)–­Med(IQR)P ­value
    All health facilities3.4 (2.0–­­5.9)Reference value
    Kenyatta National Hospital (KNH) only9.6 (6.5–­­14.1)P<0.001
    KNH+17.4 (5.6–­­11.0)P<0.001
    KNH+26.8 (4.3–­­9.6)P<0.001
    • *All comparisons by Kruskal-­Wallis with Dunn’s post test.

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Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage
Brian I Shaw, Ali Akida Wangara, Gladys Mbatha Wambua, Jason Kiruja, Rochelle A Dicker, Judith Mutindi Mweu, Catherine Juillard
Trauma Surg Acute Care Open Dec 2017, 2 (1) e000130; DOI: 10.1136/tsaco-2017-000130

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Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage
Brian I Shaw, Ali Akida Wangara, Gladys Mbatha Wambua, Jason Kiruja, Rochelle A Dicker, Judith Mutindi Mweu, Catherine Juillard
Trauma Surg Acute Care Open Dec 2017, 2 (1) e000130; DOI: 10.1136/tsaco-2017-000130
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Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage
Brian I Shaw, Ali Akida Wangara, Gladys Mbatha Wambua, Jason Kiruja, Rochelle A Dicker, Judith Mutindi Mweu, Catherine Juillard
Trauma Surgery & Acute Care Open Dec 2017, 2 (1) e000130; DOI: 10.1136/tsaco-2017-000130
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