Financial risk of road traffic trauma care in public and private hospitals in Addis Ababa,Ethiopia: A cross-sectional observational study

BackgroundRoad traffic injuries are among the most important causes of morbidity and mortality and cause substantial economic loss to households in Ethiopia. This study estimates the financial risks of seeking trauma care due to road traffic injuries in Addis Ababa, Ethiopia.MethodsThis is a cross-sectional survey on out-of-pocket (OOP) expenditures related to trauma care in three public and one private hospital in Addis Ababa from December 2018 to February 2019. Direct medical and non-medical costs (2018 USD) were collected from 452 trauma cases. Catastrophic health expenditures were defined as OOP health expenditures of 10% or more of total household expenditures. Additionally, we investigated the impoverishment effect of OOP expenditures using the international poverty line of $1.90 per day per person (adjusted for purchasing power parity).ResultsTrauma care seeking after road traffic injuries generate catastrophic health expenditures for 67% of households and push 24% of households below the international poverty line. On average, the medical OOP expenditures per patient seeking care were $256 for outpatient visits and $690 for inpatient visits per road traffic injury. Patients paid more for trauma care in private hospitals, and OOP expenditures were six times higher in private than in public hospitals. Transport to facilities and caregiver costs were the two major cost drivers, amounting to $96 and $68 per patient, respectively.ConclusionSeeking trauma care after a road traffic injury poses a substantial financial threat to Ethiopian households due to lack of strong financial risk protection mechanisms. Ethiopia's government should enact multisectoral interventions for increasing the prevention of road traffic injuries and implement universal public finance of trauma care.     

The burden of road traffic injuries in South Asia: a commentary

Around 238,000 people die in road crashes every year in South Asian countries. However, no information on road traffic injuries in South Asian countries is available to estimate the magnitude of the problem in terms of the various levels of severity. It has been estimated that for one RTI death, there are 20 hospitalizations, 50 emergency room visits, and more than 100 minor injuries. Together with the social impact in terms of pain, grief and suffering, RTIs impose a very large economic burden on the countries affected. Considering a gross estimate of 1% of GDP as economic loss from RTIs in South Asian countries runs into US$ 25 billion a year which is more than 50% the total annual amount of development assistance worldwide. The main reasons for high burden of road traffic injuries in this region are growth in the number of motor vehicles, poor enforcement of traffic safety regulations, poor quality of roads and vehicles, and inadequate public health infrastructures.     

Road traffic injuries in Mozambique

Road traffic injuries affect the economy, health and quality of life of the people of Mozambique. Current road safety programmes are inadequate and inefficient given the magnitude of the problem. Data reported on road traffic crashes in the period 1990 to 2000 from the National Institute for Road Safety, the traffic police and the Central Hospital of Maputo were reviewed. The burden of road traffic injuries in Mozambique is rising, with at least three people killed daily. The age group most affected is 25-38 (39.35%), followed by 16-24 (20.79%). The main causes of crashes include reckless driving, drunken driving, roads with potholes, inadequate signs, lack of protection for pedestrians, and inadequate traffic law enforcement. However, the data are not adequate to reveal the true magnitude of the problem. Data collected by different sources are incomplete and not coordinated with other sources and databases. In urban areas, however, better response to crashes, treatment of the injured, reporting and data collection is attributable to a greater concentration of police and medical facilities. Road traffic safety programmes in Mozambique are inadequate and inefficient, starting with the data collection system. Improvement of injury surveillance systems is needed to help make road traffic safety a national development agenda priority and for developing and implementing road safety policies. For road safety programmes to be effective, government must facilitate stakeholders' involvement, and the clear definition of government activities, civil society activities and public-private partnerships need to be established.     

The cost of inpatient burn management in Nepal

IntroductionThe management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal.MethodsWe conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting.ResultsExperts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A ‘typical’ burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively.ConclusionThis study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.     

The Burden of High-Energy Musculoskeletal Trauma in High-Income Countries

Introduction to the problem

Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future.

Review of literature

In 2016, mortality from road traffic injuries (RTIs) between the ages of 15–49 was reported to be 9.5% (9.0–9.9) in high-income countries, accounting for approximately 255 million DALYs. While RTIs do not fully capture the extent of high-energy musculoskeletal trauma, as the most common mechanism, they serve as a useful indicator of the impact on the surgical and economic burden. In 2009, the global losses related to RTIs were estimated to be 518 billion USD, costing governments between 1 and 3% of their gross domestic product (GDP). In the last decade, both the total direct per-person healthcare cost and the incremental direct per-person costs for those with a musculoskeletal injury in the USA rose 75 and 58%, respectively.

Future directions: addressing the gaps

While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD–DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.

     

Pre-hospital trauma care resources for road traffic injuries in a middle-income country—A province based study on need and access in Iran

Background

Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran.

Methods

This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities.

Results

RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country.

Conclusions

The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.     

Public hospital-based level I trauma centers: financial survival in the new millennium

BACKGROUND: The medical benefits of trauma centers have been well documented; studies have reported substantial financial losses attributed to trauma care. This study demonstrates the dependence of Level I trauma centers on Disproportionate Share Hospital (DSH) governmental funds and tax dollars. Furthermore, specific injury groups have greater dependence on these funds. METHODS: Records of 553 trauma patients admitted to a public urban Level I trauma center during a 6-month period were reviewed. Patients were grouped according to blunt, penetrating, and thermal injuries. Data for each group included charges, costs, payments, and the source of reimbursement. Profit and loss margins were compared with and without government funds. RESULTS: With diminished DSH funds and tax dollars, a net loss over $2.1 million was incurred. The greatest disparity originates from Medicaid, self-pay, and prisoner patient groups. Inclusion of government funds provided a positive return of over $600,000. CONCLUSION: The financial stability of urban public Level I trauma centers without additional funding is tenuous because of a high proportion of uninsured and underinsured patients. Government tax dollars and DSH funds are required for their continued solvency.     

Road traffic injuries as seen in a Nigerian teaching hospital

Trauma is a major problem in both developing and developed countries. World wide road-traffic injuries (RTIs) represent 25% of all trauma deaths. Injuries cause 12% of the global disease burden and are the third commonest cause of death globally. In our own environment, trauma is also important, with RTIs being a leading cause of morbidity and mortality. There is limited data on RTIs in West African countries, and this necessitated our study. We aimed to find common causative factors and proffer solutions. This was a one year prospective study examining all cases of trauma from RTIs seen at the Accident and Emergency Department of the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki, Nigeria. Three hundred and sixty-three patients were studied. There was a male/female ratio of 3.4:1, with the modal age being 25 years. Most injuries involved motorcycles (54%). Passengers from cars and buses were also commonly affected (34.2%). Most of accidents occurred from head-on collisions (38.8%). Soft-tissue injuries and fractures accounted for 83.5% of injuries. The head and neck region was the commonest injury site (41.1%), and the most commonly fractured bones were the tibia and fibula (5.8%). Death occurred in 17 patients (4.7%), and 46 (12.7%) patients discharged themselves against medical advice. Improvements in road safety awareness, proper driver education—especially motorcycle drivers—and proper hospital care are needed in our subregion.     

Variations in hospital costs after traffic injuries: The importance of sociodemographic aspects and comorbidities

ObjectiveThe impact of sociodemographic aspects and comorbidities on the inpatient hospital care costs of traffic victims are not clear. The main goal of this study is to provide insights into the sociodemographic characteristics and clinical conditions (including comorbidities) of the victims that result in higher hospital costs.ParticipantsFor the period 2009–2011, people admitted to a hospital as a result of a road traffic crash (N = 64,304) were identified in the national Minimal Hospital Dataset, after which they were linked to their respective claims data from the sickness funds.MethodsA generalized linear model was used to analyse hospital costs controlling for roadway user categories, demographics (gender, age, individual socioeconomic status (SES)), and clinical factors (the nature, location, and severity of injury, and comorbidities).ResultsThe median hospital cost was € 2801 (IQR € 1510–€ 7175, 2015 Euros). There was no significant difference between gender. Low SES inpatients incurred 16% (95% CI: 14%–18%) higher hospital costs than inpatients of high SES. The presence of comorbidities was associated with an increased hospital cost, however with varying magnitude. For example traffic victims suffering from dementia incur significantly higher hospital costs than those who were not (49% higher, 95% CI: 44%–53%), whereas diabetes was associated with a smaller increase in costs compared to non-diabetics (13%, 95% CI: 10%–16%).ConclusionComorbidities and low SES are associated with higher hospital costs for traffic victims, notwithstanding their age, and the nature and the severity of their injury. The broad variability of hospital costs among trauma inpatients should be accounted for when reconsidering financing models. Furthermore, the strong predictive value of some comorbidities and SES on hospital costs should be considered when projections of future health care utilisation in traffic safety scenarios are prepared.     

Road traffic injuries: a new agenda for child health

This paper reviews literature related to morbidity and mortality in South Asian children due to Road Traffic Injuries (RTIs), almost all of which are preventable. In South Asia after males 15-44 years, RTIs are most common in children 0-15 years old. Under-five fatality rates are about six times higher than in the developed world. Most injuries in low income countries occur in urban areas, where pedestrians, passengers, and cyclists account for around 90% of deaths due to RTIs. This higher fatality among pedestrians is probably due to wider traffic mix and lack of safe pedestrian walking areas. The WHO estimates that RTIs cost countries between 1 and 2% of their Gross Domestic Product. This has critical financial consequences. Vital statistics in South Asia are not reliable, and this leads to an underestimation of the magnitude of RTIs that hampers efforts for its acceptance as a preventable public health problem. Rapid urbanization, high motorization rates and failure to institute preventive measures predict a substantial increase in road traffic deaths in the coming years. Creating a safer environment is important. Use of child passenger restraints, bicycle helmets and targeted education campaigns are effective preventive measures. Legislation and implementation of traffic rules and regulations, road engineering and safe pedestrian areas would help reduce injuries. These measures are in accordance with the WHO's five-year strategy to address RTIs worldwide. This strategy includes national and local capacity building, inclusion of RTI in the public health agendas in the world for prevention and control of the health consequences. Child health in South Asia needs to integrate the new challenge of road traffic injuries for the region. It is critical that interventions for reducing this burden are developed, tested and implemented.     

Trauma center downstream revenue: the impact of incremental patients within a health system

BACKGROUND: The purpose of this study is to assess the downstream clinical and financial impact of a trauma, burn, and emergency surgery service at an academic Level I trauma center. METHODS: All patients admitted to the trauma, burn, and emergency surgery service from fiscal years 2002 to 2004 were identified. Clinical and financial data including inpatient and outpatient activity were analyzed for 365 days (downstream) after initial service admission. Data were divided into total service, trauma and burn, inpatient, outpatient, hospital, and professional revenue. RESULTS: In all, 3,679 patients were admitted during the study period with total initial revenue approaching $103 million. Of these, 1,566 patients were subsequently admitted for downstream inpatient activity, resulting in almost $26 million in subsequent inpatient revenue. The initial patient admissions resulted in over 17,000 clinic visits during the course of the 3 study years. Professional revenue resulted in over $14 million for the initial admission and $6.1 million in downstream revenue during the study period. CONCLUSIONS: Trauma, burn, and emergency surgical services result in both substantial initial and downstream revenue for the hospital (inpatient and outpatient) and professional components. Services committed to caring for the injured and emergent patients substantially contribute to the institutional financial strength.     

Incidence and trend of road traffic injuries and related deaths in Kuwait: 2000-2009

Road traffic injuries (RTIs), disabilities and deaths are recognised as a major public health problem worldwide. This study aimed to quantify the magnitude and the trends of RTI-related fatal and non-fatal injuries in Kuwait for the period 2000-2009. Data on road traffic crashes and related events (i.e., fatal and non-fatal minor and severe injuries) were obtained from police records, and the population data were sought from Ministry of Interior, Kuwait. From 2000 to 2009, 11,591 non-fatal RTIs and 3891 RTIs-related deaths occurred in Kuwait. Non-fatal severe RTIs accounted for 28.2% of the total non-fatal RTIs. Of the 2945 RTI-related deaths that occurred from 2003 to 2009, majority were amongst males (87.3%) and in the age range of 20-59years (70.8%). The mean (SD) annual mortality rates for the 10-year study period (2000-2009) were 14 (1) per 100,000 population and 36 (2) per 100,000 registered vehicles. From 2000 to 2009, population-based and registered vehicle-based overall RTI-related crude mortality rates decreased by 20% and 29%, respectively. However, Poisson regression analyses showed that the overall slightly decreasing trends were statistically non-significant both for population-based crude mortality rate (trend coefficient=-0.016; p(trend)=0.587) and registered vehicle-based crude mortality rate (trend coefficient=-0.024; p(trend)=0.192). Furthermore, the trend in population-based age-adjusted RTI-related mortality rate for 2003-2009 was also statistically non-significant (trend coefficient=-0.050; p(trend)=0.284). For non-fatal severe RTIs, the overall mean (SD) annual rates per 100,000 population and 100,000 registered vehicles were 44 (23) and 113 (60) with corresponding total reduction of 61% and 66% from 2000 to 2009. The overall declining trends in minor and severe RTI rates (both population based and registered vehicles based) were statistically significant (p(trend)<0.001). Despite declined minor and severe RTI rates, the RTI-related crude and age-adjusted mortality rates during the past decade continued to be high for a high-income country. Targeted interventions may help reduce the burden of minor and severe RTIs and related deaths in Kuwait and other countries in the region.     

Socio-economic cost and health-related quality of life of burn victims in Spain

ObjectivesThe aim of the study was to determine the economic burden (direct and indirect costs) of burn victims and the impact of burn on health-related quality of life in Spain.MethodsIn 2003, a cross-sectional study was carried out with 898 burned people. Data regarding demographic features, health resource use, informal care, indirect costs and quality of life were prospectively collected through hospital admission databases and questionnaires filled out by burn victims and caregivers.ResultsThe mean annual cost (direct and indirect) per burn patient was US$ 99,773. The most important categories of costs were those of in-patient care and temporary and permanent disability. Direct healthcare costs of burn patients represented 19.6% of the total. Total annual cost for burn patients in Spain was US$ 313 million. The mean health-related quality of life measured by European Quality of Life 5-Dimension score was 0.84 and the mean visual analogue score was 67.ConclusionsThe costs of burn are higher than those of many other conditions, and a cost-effectiveness assessment of the different interventions for burn should become a priority in health policy.     

Ethical dilemmas of health care in the developing nations

Limited resources, widespread poverty, and the absence of health insurance pose daily ethical problems for Third World physicians, who must balance their roles as individual patient advocates against a desire to provide health care to the greatest number of children. Pakistan has a per capita income of Rs. 7,220 (US$ 380) per year, or Rs. 800 (US$ 32) per month. The annual population growth of the country is 3.1%, and approximately 360,000 infants are born each year in Karachi, the largest city in the country. The Aga Khan University Hospital, a private teaching institution, is the only hospital in Karachi with a Level III Neonatal Intensive Care Unit (NICU). The financial and medical data of 200 infants admitted to the NICU in 1988 were reviewed retrospectively, and compared with those of two specific subgroups. (1) Among 15 infants who underwent surgical intervention, the average total cost of hospitalization was Rs. 36,040 (US$ 1,900) per patient, with an average daily cost of Rs. 923 (US$ 49). The longest hospital stay was 6 months, for a child who had total colonic aganglionosis associated with a short gut syndrome. There were two deaths in this group. (2) Of the 21 premature neonates admitted having Idiopathic Respiratory Distress Syndrome (IRDS) during this period, the total hospitalization cost per patient was Rs. 23,260 (US$ 788), with a daily cost of Rs. 1,050 (US$ 55). Eleven patients required ventilatory support. There were 16 survivors. Among both groups, 6% of all revenues generated in the NICU were used to help families pay for the bills under a welfare scheme.     

Inpatient costs of fire-related injuries in Finland

The aim of this study was to approximate the direct health care costs of fire-related injuries in inpatient care in Finland.Using the PERFECT costing method, cost data from both Finnish burn centres were linked to the fire-related injury patient data from the Finnish National Hospital Discharge Register (FHDR, 2001–2009). Additionally, a sample of 168 patients from the Helsinki Burn Centre was linked to the FHDR to examine the relation of %TBSA.Burn was involved in approximately 77% of the cases, the remainder consisting mainly of combustion gas poisonings. Burns were generally much more expensive to treat. Fire-related injuries incurred EUR 6.2 million per year in inpatient costs for the whole country. Mean cost per burn patient was EUR 25,000 and for combustion gas poisoning it was EUR 3600. As expected there was a strong relationship between %TBSA and cost. Older age had a strong effect on costs. The most severe injuries cost over EUR 400,000 to treat. Approximately 7–8% of the most expensive cases constitute 50% of the total costs. Successful prevention of extreme cases would yield considerable savings in relation to total annual inpatient care costs. However, a cost–benefit analysis would be needed.     

Economic cost of home-telemonitoring care for BiPAP-assisted ALS individuals

Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40 consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital, office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs considered days of wages lost due to absenteeism. G1 included 20 patients aged 60?±?10 years and G2 included 19 patients aged 62?±?13 years. Results showed that no differences were found regarding clinical/demographic characteristics at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64% average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant), telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year.     

The benefits of a centralized remote surveillance program for vascular patients

ObjectiveWe aimed to assess the clinical and financial utility of a centralized remote surveillance program for vascular patients compared with traditional outpatient follow-up.MethodsIn 2014, the Royal Adelaide Hospital Department of Vascular Surgery introduced a centralized remote surveillance program where suitable patients were monitored by remote imaging in lieu of traditional outpatient appointments (OPAs). Surveillance imaging was performed at a site local to the patient and was reviewed centrally by a dedicated surveillance nurse. We undertook a 5-year retrospective analysis of the program’s prospectively maintained database since its inception. Costs for inpatient admissions and OPAs were retrieved from hospital financial databases. The surveillance database and electronic patient records were analyzed for number and outcome of surveillance scans, interventions, and OPAs. Additional savings in travel distance, fuel costs, and CO₂ emissions were also calculated.ResultsOver 5 years, 1262 patients underwent a mean of four scans per patient. A total of 3718 OPAs were saved, approximating 930 hours of clinic and consultant time, with associated savings of Australian (A)$1,524,900 (United States [US]$ 1,065,684) over 5 years (A$ 304,980 [US$ 213,137] per year). For every OPA avoided, each patient saved 197 km travel and A$87 (US$ 61) fuel costs, with an associated 115 kg of CO₂ emissions saved. Over 5 years, this equated to savings of 248,173 km travel, A$ 110,136 (US$ 76,969) fuel costs, and 146 tons of CO₂ emissions. A total of 134 surveillance-detected pathologies (10.6%) required intervention, a further 28 despite surveillance (2.2%), and three following surveillance cessation (0.2%). Subgroup analysis demonstrated that interventions despite surveillance were three times more expensive and incurred four times longer admissions than those due to surveillance.ConclusionsRemote vascular surveillance, particularly applicable in our current COVID-19 pandemic climate, is associated with quantifiable financial, clinical, patient, and environmental beneficial outcomes and can be safely delivered to populations spanning large geographical areas such as those in Australia.     

Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA

This study evaluates the impact of pediatric uninary tract infection (UTI)s on the economy and inpatient healthcare utilization in the USA. A retrospective analysis of patient demographics and hospital economics was performed on children less than 18 years of age admitted with a UTI between 2000 and 2006 using the Healthcare Cost and Utilization Project Kids’ Inpatient Database. Our results were stratified as follows. Hospital admissions—nearly 50,000 children/year were admitted with a UTI. Pediatric UTIs represented 1.8% of all pediatric hospitalizations. Seventy-three percent of patients were female and 40% were under 1 year of age. Payer information—from 2000 to 2006, pediatric insurance coverage shifted from the private sector to the public sector. Hospital cost—in 2000, estimated hospital costs for UTIs were $2,858 per hospitalization and rose to $3,838 by 2006. Mean hospital charges increased from $6,279 to $10,489 per stay. By 2006, aggregate hospital charges exceeded $520 million. Our results indicate that UTIs are among the most common pediatric admission diagnoses. Hospitalization is more common in females and younger children. Since 2000, hospital charges for UTIs increased disproportionately to hospital costs. Over time, more children hospitalized with a UTI depend on public agencies to cover healthcare expense. More efforts are needed to evaluate cost-effective strategies for evaluation and treatment of UTIs.     

Cost Implications of African Swine Fever in Smallholder Farrow‐to‐Finish Units: Economic Benefits of Disease Prevention Through Biosecurity

African swine fever remains the greatest limitation to the development of the pig industry in Africa, and parts of Asia and Europe. It is especially important in West and Central African countries where the disease has become endemic. Biosecurity is the implementation of a set of measures that reduce the risk of infection through segregation, cleaning and disinfection. Using a 122‐sow piggery unit, a financial model and costing were used to estimate the economic benefits of effective biosecurity against African swine fever. The outcomes suggest that pig production is a profitable venture that can generate a profit of approximately US$109 637.40 per annum and that an outbreak of African swine fever (ASF) has the potential to cause losses of up to US$910 836.70 in a single year. The implementation of biosecurity and its effective monitoring can prevent losses owing to ASF and is calculated to give a benefit‐cost ratio of 29. A full implementation of biosecurity will result in a 9.70% reduction in total annual profit, but is justified in view of the substantial costs incurred in the event of an ASF outbreak. Biosecurity implementation is robust and capable of withstanding changes in input costs including moderate feed price increases, higher management costs and marginal reductions in total outputs. It is concluded that biosecurity is a key to successful pig production in an endemic situation.     

A hospital based surveillance system to assess the burden of trauma in KwaZulu-Natal Province South Africa

IntroductionIn response to the ongoing excessive burden of trauma in South Africa the Data Management and Epidemiology Units of the Department of Health in conjunction with a group of trauma specialists developed a number of trauma data variables for inclusion on the routine District Health Information System (DHIS). The aim of this study is to describe the process followed and review the 2012–2014 data.MethodologyThe variables collected included: total patient numbers assessed in the emergency room with a diagnosis of trauma; the mechanisms of trauma (blunt assault, motor vehicle accident, pedestrian vehicle accident, stab, gunshot wound, other); any trauma patient admitted to a health facility ward/ICU for longer than 12 h; and whether the patient required transfer to a higher centre of care. All trauma deaths in hospital were recorded. The severity of trauma was measured using the Emergency Medical Services (EMS) classification of blue code (dead), red code (stretcher case with deranged physiology), yellow code (stretcher case with normal physiology) and green code (able to walk with normal physiology. The DHIS trauma data from April 2012 to March 2014 was reviewed.ResultsThere were 197,219 emergency room visits for trauma in KZN in the 2013/2014 financial year. This constitutes 27.0% of all emergency room visits. The ratio of intentional to non-intentional injury is 45:55. There were 18,716 admissions to public sector hospitals for trauma in KZN in the 2013/2014 financial year. This constitutes 2.4% of all admissions in the province. There were 1045 inpatient deaths due to trauma in the same period, constituting 2.5% of all inpatient deaths. The overall rate of trauma in KZN was 17 per 1000 population.ConclusionThe adapted DHIS has successfully collected essential data that quantify the hospital burden of trauma in KZN province. This has provided the most complete overview of the burden of trauma in the Province. These trauma indicators should remain a permanent part of the DHIS to allow planners to track the trauma epidemic and to institute informed management strategies.