Improving the management of open tibia fractures, Malawi

Schade, A. T. et al. (2024) Improving the management of open tibia fractures, Malawi. Bulletin of the World Health Organization, 102(4), pp. 255-264. (doi: 10.2471/BLT.23.290755) (PMCID:PMC10976873)

Abstract

Objective: To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures. Methods: We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures. The primary outcome was a before-and-after comparison of the self-reported short musculoskeletal function assessment score, a measure of patient function. Secondary outcomes included clinical management; and clinician knowledge and implementation evaluation outcomes of 57 health-care providers attending the course. We also constructed multilevel regression models to investigate associations between clinical knowledge, patient function, and implementation evaluation before and after the intervention. Findings: The median patient function score at 1 year was 6.8 (interquartile range, IQR: 1.5 to 14.5) before intervention and 8.4 (IQR: 3.8 to 23.2) after intervention. Compared with baseline scores, we found clinicians’ open fracture knowledge scores improved 1 year after the intervention was implemented (mean posterior difference: 1.6, 95% highest density interval: 0.9 to 2.4). However, we found no difference in most aspects of clinicians’ open fracture management practice. Conclusion: Despite possible improvement in clinician knowledge and positive evaluation of the intervention implementation, our study showed that there was no overall improvement in clinical management, and weak evidence of worsening patient function 1 year after injury, after implementation of the open fracture intervention bundle.

• Item Type: Articles
• Additional Information: This research was funded by the Wellcome Trust (Grant number 203919).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Schade, A. T., Sabawo, M., Jaffry, Z., Nyamulani, N., Mpanga, C. C., Ngoie, L. B., Metcalfe, A. J., Lalloo, D. G., Harrison, W. J., Leather, A., and MacPherson, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Bulletin of the World Health Organization
• Publisher: World Health Organization
• ISSN: 0042-9686
• ISSN (Online): 1564-0604
• Published Online: 29 February 2024
• Copyright Holders: Copyright © 2024 Emerald Publishing Limited
• First Published: First published in Bulletin of the World Health Organization 102(4):255–264
• Publisher Policy: Reproduced under a Creative Commons License