Management of Traumatic Brain Injury in Low Resourced Settings

Original Editor - Add a link to your Physiopedia profile here.

Top Contributors - Naomi O'Reilly, Kim Jackson, Admin, Rachael Lowe, Eugenie Lamprecht, Uchechukwu Chukwuemeka, Tony Lowe and Jess Bell  

Introduction

Global resources are not equally distributed. Low resource settings are generally in countries defined by the World Bank as Low-Income Countries (LICs), but low resource settings and low-income countries are not always synonymous. Resource inequalities can also occur within countries e.g.wealthy subgroups in low-income countries may have access to high resource private healthcare facilities, while poorer subgroups in middle-income countries might utilise low resource, state-run facilities or in some cases have no acces to health care.

A large proportion of the population in low resource settings, live below the poverty line of $1.25 per day, and face challenges concerning health information, access to healthcare, transportation and out-of-pocket payments. Low resource settings are typically characterized by a lack of funds to cover health care costs, on individual or societal basis, often resulting in one or more of the following:

• Decreased Annual Spend on Health e.g. Low-income countries only spend on average of $32 on health per person per year, while high-income countries spend on average $4600
• Fewer or less‐trained Health Care Personnel e.g. Low-income countries have an average of 2.5 doctors per 10,000 population while high-income countries have 28.7 per 10,000 population
• Under‐developed infrastructure including electrical power, transportation, controlled environment, buildings
• Limited access to medication, medical equipment, supplies, and devices
• Limited Emergency Medical Services
• Limited Critical Care and Iintensive Care Unit availability
• Limited access to maintenance and parts
• High Equipment costs often lead to les frequent replacement and often old equipment
• Limited Health Care Regulation

Burden of Traumatic Brain Injury

Low resource settings have a disproportionate amount of the global burden of traumatic brain injury. Primary causes of traumatic brain injury vary by age, socioeconomic factors, and geographic region, so any planned interventions must take into account this variability. Low and medium-income countries, which face a higher preponderance of risk factors for causes of traumatic brain injury and have inadequately prepared health systems to address the associated health outcomes, experience nearly three times more cases of traumatic brain injury proportionally than high income countries, with Southeast Asian and Western Pacific regions experiencing the greatest overall burden. Estimates suggest that up to 80% of individuals living with traumatic brain injury related impairment live in Low and medium-income countries, but at the same time in those regions only 2% of these individuals have access to rehabilitation services to support their quality of life.

Resources

Ramesh A, Fezeu F, Fidele B, Ngulde SI, Moosa S, Gress D, Calland JF, Petroze R, Young JS, Nkusi AE, Muneza S. Challenges and solutions for traumatic brain injury management in a resource-limited environment: example of a public referral hospital in Rwanda . Cureus. 2014 May 9;6(5):e179.

Rubiano AM, Puyana JC, Mock CN, Bullock MR, Adelson PD: Strengthening neurotrauma care systems in low and middle income countries. Brain Inj 2013, 27:262-72.

Harris, O. A., Bruce, C. A., Reid, M., Cheeks, R., Easley, K., Surles, M. C., Pan, Yi., Rhoden-Salmon, D., Webster, D., and Crandon, I. (2008). Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome. Journal of Neurosurgery JNS 109, 3, 433-438

Bashford T, Clarkson PJ, Menon DK, Hutchinson PJ. Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low-income and middle-income countries. BMJ global health. 2018 Mar 1;3(2):e000768.

Tran TM, Fuller AT, Kiryabwire J, Mukasa J, Muhumuza M, Ssenyojo H, Haglund MM. Distribution and characteristics of severe traumatic brain injury at Mulago National Referral Hospital in Uganda. World neurosurgery. 2015 Mar 1;83(3):269-77.

Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation. 2007 Jan 1;22(5):341-53.

Prasad GL, Anmol N, Menon GR. Outcome of traumatic brain injury in the elderly population: a tertiary center experience in a developing country. World neurosurgery. 2018 Mar 1;111:e228-34.