Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey

Abstract

Introduction: The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care.

Method: We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages.

Results: 228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]).

Conclusions: Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.

Fig 1. Health facility staff perceptions of importance for each of the Three Delays.

Whilst delay 3 was not considered by most participants to either affect the largest number of people, nor cause the longest delay, most participants considered it the most amenable to change and the most important delay overall.

Fig 2. Health facility staff perceptions of the proportion of patients delaying seeking and receiving care.

Most participants thought half or more patients delayed seeking care, but few or no patients experienced delays in receiving care.

Fig 3. Health facility staff perceptions of time delays to seeking and receiving care.

Most participants thought delays in patients seeking care were typically 2 hours or longer, whereas most thought delays in receiving care were less than 1 hour.

Fig 4. Health facility staff perceptions of patient harm associated with each delay.

A substantial majority of participants considered patients with delays to seeking care, delays to reaching care of more than 4 hours and delays in receiving care suffered significant or very significant harm.

Fig 5. Health facility staff perceptions of the proportion of injured patients reaching care within given time frames from injury.

The majority of participants thought few injured patients could reach care within 2 hours.

Fig 6. Frequency of barriers reported by health facility staff within the top 3 most important overall (colour coded by delay stage).

Barriers from delay 3 were more frequently considered within the top 3 most important overall by participants.