School of Public Health and Community Medicine

Action needed to improve fracture care in low- and middle-income countries

Fractured leg image

New research published in The Lancet Global Health reveals a major lack in timely hospital care for fractures in low- and middle-income countries.   

Globally, injuries are one of the leading cause of death and disability, with 90% of injuries occurring in low- and middle-income countries. 

For the first time, researchers have examined the frequency and risk of delays in essential fracture care in hospitals in low- and middle-income countries. They found 72% of patients with an open fracture (with broken skin or wound) were not admitted within the two hour 'standard' target for care, and 28% of those with a closed fracture waited over 24 hours. 

The findings highlight a major gap in these countries' health systems that is putting lives at risk, but one that can be addressed, says Professor Rebecca Ivers, Asia-Pacific study lead and Head of the School of Public Health and Community Medicine at UNSW.   

"The longer it takes for a person with a fracture to receive the care they need, especially someone with an open wound, the more at risk they are of complications and life-threatening infections such as sepsis," says Professor Ivers.  

"Our research shows that hospital systems responsible for delays in fracture care must be a priority, for example improving ambulance services and referral systems between hospitals and other health facilities," she says 

"While reasons for delays in admission significantly differed by region, it is crucial in all countries that more patients are transported to a treating hospital in a timely manner."   

Improving the capacity for hospitals to diagnose and admit patients with hip, spine, and pelvic fractures, and pre-hospital factors such as a patient's health insurance, were also shown to be important.   

Each year, approximately 53% of premature deaths in low- and middle-income countries can be addressed by improving emergency care systems.  

"The implications from our findings and all available evidence are concerning - low- and middle-income countries are falling behind in achieving global targets in access to fracture care and are failing at the first step of the emergency-care system," says Professor Ivers.   

"During a time of a public health crisis, like COVID-19, the problem only gets worse as these overstretched health systems struggle even more to meet demand. Through pro-active and system-wide prevention measures lives can be saved." 

The study, called INORMUS, is a collaboration between the UNSW School of Public Health and Community Medicine, The George Institute for Global Health, and McMaster University. It looked at 31,255 patients in 49 hospitals in 18 low- and middle-income countries, and to date, is the largest observational study to quantify delays in hospital admissions in patients with fractures. The study is funded by the National Health and Medical Research Council of Australia, Canadian Institutes of Health Research, McMaster Surgical Associates, and Hamilton Health Sciences. 

In the regions assessed, patients in China and Africa were the least delayed in their admission to a treating hospital, while those in Latin America were the most delayed. 

View the full paper here.

 For more information about INORMUS click here.

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School of Public Health and Community Medicine (SPHCM)