Trauma rehabilitation in a teaching hospital in Antananarivo, Madagascar: current provision and patients’ perspectives

Abstract

Purpose: This study aims to describe the current provision of trauma rehabilitation in Antananarivo, Madagascar and explore the experiences and perspectives of users of this service in order to inform future research and service development.

Material and methods: A qualitative study supplemented by a descriptive service review were applied in the central government hospital in Antananarivo. Registers in the rehabilitation department were analyzed for a 3 month period. Semi-structured interviews were conducted with a convenience sample of users of the rehabilitation service and were subject to thematic analysis.

Results: One in six patients treated in the rehabilitation department has survived a traumatic injury, with limb injuries comprising the majority. Analysis of interviews with 10 adult patients, following traumatic injuries to the lower limbs (6), upper limbs (3) or polytrauma (1) generated seven broad themes: health seeking behavior, organization of services, clinical management, costs and financial impact, effect on function and role, psychological impact and societal attitudes.

Conclusions: Financial constraints and impact on personal finances pervade the overall picture. The perspectives and experiences elucidated will inform future research into the development of context-specific models of care for people with trauma-related disabilities in Madagascar.

Implications for rehabilitation

• Potentially treatable traumatic injury can have a profound effect on function and societal participation in Madagascar.

• Interventions to increase access to timely acute trauma care and rehabilitation are needed, and may include different models of financing and innovations to reduce materials costs and length of stay.

• A structured rehabilitation pathway must be integrated to the earliest stages of trauma care, including scrutinizing the use of prolonged immobilization.

• Consideration should be given to models of care which are financially and geographically accessible to the population.

Keywords:

• Rehabilitation
• trauma
• injury
• disability
• patient perspectives

Acknowledgements

The authors would like to thank the participants for sharing their time and perspectives, the staff who facilitated the study and the interpreters Cédric Randrianjatovonala and Liantsoa Ratsimbason. We would also like to thank Prof. Luc Samison, Dean of the Faculty of Medicine at the University of Antananarivo for his support and Dr Jennifer Parr of the Leeds Institute of Health Sciences for her support and advice.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This research is supported by the National Institute for Health Research (NIHR) infrastructure at Leeds. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.