D-SINE

Overview

Our long-term goal is to significantly improve health in sub-Saharan Africa (SSA). Approximately 9% of the world’s deaths, more than 5 million deaths annually, are due to injury. The research and funding investment in the study of injury is not commensurate to the magnitude of the problem. The people of sub-Saharan Africa (SSA) are disproportionately affected by injury. To significantly improve the health in SSA, there is an urgent need for effective, innovative, and scalable approaches to reduce morbidity and mortality from injury. In SSA countries like Cameroon, injured people face multiple obstacles to trauma care, including potentially lifesaving follow-up care after hospital discharge. Our community-based survey of 8,065 patients in Southwest Cameroon found that 34.6% of injured respondents did not seek immediate formal care after injury, and another 9.9% only sought formal care after alternative means, such as traditional medicine practitioners. However, initial receipt of formal care is only the first of several necessary steps in recovery. In Cameroon, for the 65.4% of injured people who seek formal care after injury, therapeutic itineraries can be complex, often involving poorly supported referrals to other facilities or transitions away from formal care. As a result, formal systems of care fail to retain trauma patients for follow-up care, a missed opportunity as these patients have already overcome significant financial and personal challenges to seek initial care for their injuries. Consequently, discharged trauma patients who may benefit from follow-up care often delay care until advanced complications develop. Exacerbating this supply-side issue are patient- and household-level factors that impede care seeking, such as dissatisfaction with the length or progress of treatment and/or poverty. Trauma patients in Cameroon of lower socioeconomic status (SES) are less likely to receive follow-up care after discharge. Together, these data suggest a critical yet untapped opportunity to significantly improve health in SSA by identifying and retaining injury patients who would benefit from further care. In terms of trauma outcomes prediction, we will use data-adaptive methods to optimize the follow-up of injured patients after hospital discharge in Cameroon. Our overall objective is to improve health in SSA by identifying and retaining injury patients who would benefit from further care after initial treatment.