Trauma, a preventable burden of disease in South Africa : review of the evidence, with a focus on KwaZulu-Natal

Abstract

Trauma is a major burden of disease in lower- and middle-income countries, and to address the causes and treatment requires specialist services and multidisciplinary care. Despite this, governments have given trauma low priority as they have focused largely on primary health care. This chapter demonstrates the extensive burden of trauma in KwaZulu-Natal (KZN) and illustrates that the entire country experiences a similar disease burden. Recent data from numerous studies are used to provide insight into the options for establishing systems of quality trauma care and accreditation programmes for hospitals and systems. Current and optimal staffing of trauma-care facilities, compliance with minimum equipment standards, and the potential for patient harm are addressed. The authors show that trauma constitutes approximately 25% of the emergency workload at most public hospitals in KZN, where there is limited capacity for rehabilitation and lack of intensive care facilities. There is no defined trauma system and the existing resources at regional and tertiary public facilities are strained. The role of sound databases in providing numerical and outcome data is highlighted and a call is made for the establishment of a National Trauma Data Bank. The authors highlight the need for prevention programmes and draw attention to the cost implications of trauma care, noting the cost-benefit ratio of good trauma care compared with the litigation risk to government when such care cannot be provided.