Global neurotrauma is increasing across the globe, especially in low and middle income countries (LMICs).1-2
The public health consequences of this ‘silent epidemic’ cannot be ignored where these range from economic burden to individuals, families and governments, burden to healthcare systems, major psychological, psychiatric, social and community impact as well as demographic impact.3-4
Neurotrauma is largely preventable where many of the established causes can be avoided if appropriate measures are put in place at societal, community, household and individual levels.5-6This is especially so for road traffic collisions (RTCs), which is the leading cause of neurotrauma particularly in LMICs, where 90 percent of road traffic injuries and death occur worldwide.7
While many high income countries (HICs) have implemented multiple strategies and interventions that have significantly reduced the burden of RTCs and neurotrauma, data from LMICs show that these are lacking.1-2, 5, 8-9Also, implementing preventative strategies from HICs in LMICs may be challenging due to differences in infrastructure, population, habits, environment and resources.5, 9
In order to better understand the issues surrounding RTC prevention in LMICs, this project seeks to study the epidemiology of neurotrauma arising from RTCs and to identify factors amenable to preventative strategies in these countries. Preventative strategies would be any measures which target injury occurrence (primary prevention), provide adequate medical response to manage and minimise harm following an injury (secondary prevention), and mitigate the sequelae and reduce consequent disability (tertiary prevention).10This project utilizes a public health approach to prevention that is based on a framework adapted from the Canadian Institutes of Health Research (CIHR), and will consider Phases 1 and 2 (Figure 1).11
This exploratory mixed-methods study will be carried out in collaborator countries and will commence with a scoping exercise to map the current literature on neurotrauma and RTC prevention, and to glean contextual issues and research priorities through consultation with key informants from participant countries. This would be followed by epidemiological data collection through a prospective survey, with qualitative approach in parallel with semi-structured interviews and focus groups to provide further depth and explanation of the quantitative findings.
This research will be carried out with local collaborators and stakeholders, and the data will be used to inform the design and development of context-appropriate, sustainable preventative interventions or strategies for RTCs and neurotrauma.
Figure 1: Framework for study: adapted from the CIHR Knowledge-to-Action Framework (Hallet et al.,2015).
- Rubiano AM, Puyana JC, Mock CN, Bullock MR, Adelson PD. Strengthening neurotrauma care systems in low and middle income countries. Brain Injury. 2013; 27(3):262-272.
- Saatian MR, Ahmadpoor J, Mohammadi Y, Mazloumi E. Epidemiology and Pattern of Traumatic Brain Injury in a Developing Country, Regional Trauma Center. Bulletin of Emergency Trauma. 2018; 6 (1): 45-53.
- Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G and Kobusingye OC. The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation. 2007; 22(5): 341-353.
- Wilson MH. Traumatic Brain Injury: an underappreciated public health issue. The Lancet. 2016; 1(2): pe44.
- Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ. Belli A, Bragge P, Brazinova A et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology Commission. 2017; 16: 987-1048.
- Majdan M, Plamcikova D, Brazinova A, Rusnak M, Nieboer D, Feigin V, Maas A. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. The Lancet Public Health. 2016; 1: e67-83.
- Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Amdelgadir J et al. Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PloS ONE. 2015; 11(1): e0144971.
- Reynolds TA, Stewart B, Drewett I, Salerno S, Sawe HR, Toroyan T, Mock C. The Impact of Trauma Care Systems in Low-and Middle-Income Countries. Annual Review of Public Health. 2017; 38: 507-532.
- Razmkon A. Priorities and Concerns for Research on Neurotrauma in the Developing World. Bulletin of Emergency and Trauma. 2013; 1(1): 5-6.
- Hoz S, Moscote-Salazar LR. Prevention of Neurotrauma: An Evolving Matter. Journal of Neurosciences in Rural Practice. 2017; 8 (Suppl 1): S141-S143.
- Hallet J, Wallace D, El-Sedfy A, Hall TNT, Ahmed N et al. Optimizing Inter-Professional Communications in Surgery: Protocol for a Mixed-Methods Exploratory Study. Journal of Medical Internet Research Protocols. 2015; 4(1): e8.