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. 2023 Sep 5;4(9):676-681.
doi: 10.1302/2633-1462.49.BJO-2023-0075.R1.

Service availability and readiness for hip fracture care in low- and middle-income countries in South and Southeast Asia

Irewin Tabu  1   2 , En L Goh  3 , Duncan Appelbe  3 , Nicholas Parsons  4 , Sarath Lekamwasam  5   6 , Joon-Kiong Lee  7 , Tanawat Amphansap  8 , Dipendra Pandey  9 , Matthew Costa  3 ; FERMAT collaborators and the Global Fragility Fracture Network Hip Fracture Audit Special Interest Group
Affiliations

Service availability and readiness for hip fracture care in low- and middle-income countries in South and Southeast Asia

Irewin Tabu et al. Bone Jt Open. .

Abstract

Aims: The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines).

Methods: The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up.

Results: Responses were received from 98 representative hospitals across the five countries. Most hospitals were publicly funded. There was consistency in clinical pathways of care within country, but considerable variation between countries. Patients mostly travel to hospital via ambulance (both publicly- and privately-funded) or private transport, with only half arriving at hospital within 12 hours of their injury. Access to surgery was variable and time to surgery ranged between one day and more than five days. The majority of hospitals mobilized patients on the first or second day after surgery, but there was notable variation in postoperative weightbearing protocols. Senior medical input was variable and specialist orthogeriatric expertise was unavailable in most hospitals.

Conclusion: This study provides the first step in mapping care pathways for patients with hip fracture in LMIC in South Asia. The previous lack of data in these countries hampers efforts to identify quality standards (key performance indicators) that are relevant to each different healthcare system.

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Conflict of interest statement

D. Appelbe discloses institutional funding from the National Institute of Health Research (NIHR) and Health Technology Assessment, which is unrelated to this work. M. Costa declares that the University of Oxford receives research grant funding from the NIHR and Wellcome for research into musculoskeletal trauma, which is unrelated. N. Parsons reports payments made Warwick Medical School from the NIHR, which is also unrelated.

Figures

Fig. 1
Fig. 1
Percentage of hospitals reporting specialities involved in hip-fracture care. a) pre-surgery assessment; b) while in hospital; c) discharge plan. All axis are in 20% increments where the denominator is the number of hospitals reporting (Table I).
Fig. 2
Fig. 2
Percentage (to nearest %) of responding hospitals undertaking pre-, post-, and perioperative patient assessments.
See this image and copyright information in PMC

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