Improving the management of open tibia fractures, Malawi.

Schade, Alexander, Sabawo, Maureen, Jaffry, Zahra, Nyamulani, Nohakhelha, Mpanga, Chikumbutso Clara, Ngoie, Leonard Banza, Metcalfe, Andrew John, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Harrison, William James, Leather, Andrew and MacPherson, Peter (2024) 'Improving the management of open tibia fractures, Malawi.'. Bulletin of the World Health Organization, Vol 102, Issue 4, pp. 255-264.

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Abstract

To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures. 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. 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. 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:	Article
Subjects:	WE Musculoskeletal System > WE 20 Research (General) WE Musculoskeletal System > WE 800 Extremities > WE 870 Knee. Lower leg WO Surgery > WO 20 Research (General) WO Surgery > Traumatic Injuries > WO 700 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.2471/BLT.23.290755
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	23 Apr 2024 13:02
Last Modified:	23 Apr 2024 13:02
URI:	https://archive.lstmed.ac.uk/id/eprint/24400

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