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Road traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians.
This study examined the challenges associated with current first response practices in Malawi.
In April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer.
Access to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services.
Prehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals.
ChokothoL, MulwafuW, SinginiI, NjalaleY, Maliwichi-SenganimalunjeL, JacobsenKH. First Responders and Prehospital Care for Road Traffic Injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14–19.
Dr. Jeffrey Sach's recent United Nations report, “Investing in Development: A Practical Plan to Achieve the Millennium Development Goals,” has brought renewed discussion on the role of economic development in reducing poverty and improving health in the developing world. While much of the public debate in developed countries has focused on the amount of aid and the implementation of this proposal, there has been limited discussion on the role economic development has already played and continues to play in the improvement of health in developing countries. Increases in the GNP (gross national product), a key indicator of economic growth, are associated with an increased life expectancy at birth (figure 8.1) because of increased nutrition and decreased deaths due to infectious and parasitic diseases. Childhood immunization programs and water development projects have also played significant roles in improving child health. As people survive to older ages, the main causes of death are typically chronic and noncommunicable conditions such as heart disease and stroke. This shift in the burden of disease from infectious diseases to chronic conditions is called the “epidemiologic transition.” Developing countries' health systems are frequently ill equipped to manage the new health concerns that arise during this transition, especially those in countries that continue to face high rates of infectious disease.
Rather than following the “classic” pattern of epidemiologic transition, sub-Saharan Africa is facing what some have dubbed the “double burden” of disease because economic development is leading to an increasingly significant burden from chronic diseases while the rate of morbidity and mortality from infectious agents remains high.
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