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Orthopedic Knowledge and Need in the Provincial Philippines: Pilot Study of a Population-Based Survey

  • Christopher S. Courtney (a1) and Thomas D. Kirsch (a2)



Interventions to reduce disability from acute orthopedic injuries require a primary assessment of knowledge and need. There are no previous studies to assess this need in the remote provincial islands of the Philippines, an area recurrently affected by natural disaster.


A preliminary assessment of orthopedic knowledge and need was performed to be expanded for regional or national implementation.


Two independent surveys were conducted of households and mid-level providers who represent the first contact of care. The goal of the survey was to describe the local health care system, to identify barriers to care, and to assess gaps in knowledge for acute traumatic orthopedic injuries. Both surveys were conducted in June of 2015.

Population proportional sampling assessed a total of 100 households from 25 local Barangay communities. Questions focused on existing knowledge of acute traumatic orthopedic injuries and barriers to care.

The mid-level provider survey focused on knowledge and barriers to care regarding acute traumatic orthopedic injuries. A total of 10 school nurses and Barangay midwives representing 25 local Barangay were surveyed.


In the household population survey, 84% of respondents reported cost was either always or sometimes a barrier to care; 73% cited transportation as a barrier to care. A total of 68% of respondents reported that they would seek care at the provincial hospital for a suspected broken bone; 28% percent of respondents did not believe broken bones making an arm or leg crooked could be corrected without surgery. Only 55% percent believed care should be sought within six hours of injury, and 37% stated that more than three days after an injury was an appropriate timeframe to seek care.

Of the mid-level providers surveyed, 90% reported that they would refer possible broken bones to a higher level of care. Aggregate ranking of barriers to care from greatest to least were: cost, transportation, knowledge of time sensitive nature of treatment, religious beliefs, and other (not specified). In all, 100% reported that an education initiative regarding acute orthopedic injuries would increase the number of patients seeking care within 12 hours.


The survey describes perceived barriers to care and gaps in knowledge for acute orthopedic injuries. With some modification, this survey tool could be expanded and utilized on a regional or national level to assess gaps in knowledge and barriers to acute orthopedic care.

CourtneyCS, KirschTD. Orthopedic Knowledge and Need in the Provincial Philippines: Pilot Study of a Population-Based Survey. Prehosp Disaster Med. 2018;33(3):293298.


Corresponding author

Correspondence: Christopher S. Courtney, MD PO Box 2808 Scottsdale, Arizona USA 85252 E-mail:


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Conflicts of interest/funding: Funding for this study was provided by a grant from The Emergency Medicine Foundation (Dallas, Texas USA). Additional funding was provided by the Nothing to Lose Foundation (Phoenix, Arizona USA), a 501c3 nongovernmental organization that has worked in this community for over eight years. Both authors are affiliated with the Johns Hopkins Bloomberg School of Public Health (Baltimore, Maryland USA). The primary author is the President of the Nothing to Lose Foundation, as which has no additional institutional or commercial affiliations and no potential conflicts of interest. The primary author is also affiliated with Honor Health (Scottsdale, Arizona USA) as an attending physician in Emergency Medicine. The authors have no additional affiliations or conflicts of interest to disclose.



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