Availability and Functionality of Diagnostic Imaging Equipment for Road Traffic Crash Injury Management in Ghana: Case of Ashanti Region
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Keywords
Access to care, Diagnostic imaging equipment, Ghana, Road traffic crashes, Accident blackspot, Spatial distribution, Ultrasound, X-ray, CT, MRI
Abstract
Background/ Objective: Diagnostic imaging technologies have enhanced the understanding and management of road traffic crash (RTC) injuries and are essential for guiding the diagnosis of injuries. Despite their importance, few studies regarding their accessibility to crash-prone areas (blackspots) are available. This study sought to investigate the spatial accessibility, availability, and functionality of four essential imaging modalities (ultrasound, plain X-ray, computed tomography [CT], and magnetic resonance imaging [MRI]) for the management of RTC injuries in the Ashanti region of Ghana. Methods: A cross-sectional quantitative study was conducted covering 38 public, private, and mission-based hospitals, and seven diagnostic centers. Data were collected with a structured questionnaire on availability, functionality, and maintenance status of equipment. Spatial distance analyses between RTC blackspots (n = 104) and hospitals with imaging equipment were conducted using ArcGIS, a leading comprehensive geospatial platform, and statistical comparisons were performed using Wilcoxon Signed-rank tests. Descriptive comparative analyses were conducted to determine the functionality and maintenance status of the modalities studied. Results: The study discovered 3 MRI, 12 CT, 61 X-ray, and 108 ultrasound machines available in the region, but only 1 MRI in the public sector. While 60% of CTs (n = 12) were found in the private sector, 59% of X-rays (n = 61) and 62% of ultrasounds (n = 108) were in the public sector. The overall estimated mean travel distance from all 104 blackspots to the nearest MRI, CT, and X-ray modality was 35.43 km (± 19.80 km), 26.82 km (± 19.04 km), and 8.68 km (± 5.15 km), respectively. There was no statistically significant impact of non-functional MRI and X-ray modalities; however, travel distance to CT machines increased by 2.8 km (p < 0.001) because of the three hospital-based non-functional CTs in the region. Regarding technical support, in-house hospital-based biomedical engineers were found to possess technical expertise in maintaining X-ray and ultrasound technology, but not CT and MRI. Conclusion: This study highlights the disparities in access to diagnostic imaging equipment in the Ashanti region of Ghana. While X-ray and ultrasound modalities were well distributed across the region, access to CT and MRI was limited. Prioritization of the repair and maintenance of the non-functional CT machines in the three health facilities could improve access to this service and prevent delays to emergency care for RTC victims.
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References
2. World Health Organization (WHO). Global Status Report on Road Safety, 1st ed. Geneva, Switzerland: WHO; 2018; pp. 424. Available online: https://www.who.int/publications /i/item/9789241565684.
3. World Health Organization (WHO). Guidelines for Essential Trauma Care, 1st ed. World Health Organization (WHO), editor. Geneva, Switzerland: WHO; 2004; pp. 106.
4. Tawiah, A., Konadu-Boakye, E. Nation spends $230 m on injuries–Dr Ofori-Boadu discloses. Daily Graphic Online. 2022. Available online: https://www.graphic.com.gh/ne ws/general-news/nation-spends-230m-on-injuries-dr -ofori-boadu-discloses.html.
5. Ackaah, W., Larbi, J., Larley, J. Road Traffic Crashes in Ghana Statistics 2022. Kumasi, Ghana: Council for Scientific and Industrial Research: Building and Road Research Institute; 2024.
6. Sayed, M.J.E. Developing emergency and trauma systems internationally: What is really needed for better outcomes? J Emerg Trauma Shock. 2017;10(3):91–92. https://doi.org /10.4103/JETS.JETS_63_16.
7. Harmsen, A.M.K., Giannakopoulos, G.F., Moerbeek, P.R., et al. The influence of prehospital time on trauma patients outcome: a systematic review. Injury. 2015;46(4):602–609. https://doi.org/10.1016/j.injury.2015.01.008.
8. Hsieh, S.L., Hsiao, C.H., Chiang, W.C., et al. Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters. Eur J Trauma Emerg Surg. 2022;48(4):2709–2716.https://doi .org/10.1007/s00068-021-01816-8.
9. Pons, P.T., Markovchick, V.J. Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome. J Emerg Med. 2002;23:43–48. https://doi.org/10 .1016/S0736-4679(02)00460-2.
10. Chen, C.H., Shin, S.D., Sun, J.-T., et al. Association between prehospital time and outcome of trauma patients in 4 Asian countries: a cross-national, multicenter cohort study. PLoS Med. 2020;17(10):e1003360. https://doi.org/10.1371/journal.pmed.1003360.
11. World Bank. The State of Emergency Medical Services in Sub-Saharan Africa. World Bank: Washington, DC; 2021. Available online: https://documents1.worldbank.org/cu rated/en/356231613491787852/pdf/The-State-of-Emergency-Medical-Services-in-Sub-Saharan-Africa.pdf.
12. Mould-Millman, N.K., Dixon, J.M., Sefa, N., et al. The state of emergency medical services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283. https://doi .org/10.1017/S1049023X17000061.
13. Barron, D. (ii)Polytrauma imaging–the role of integrated imaging. Orthop Trauma. 2011;(2):83–90. https://doi.org /10.1016/j.mporth.2011.03.004.
14. Poletti, P.A., Platon, A., Becker, C.D. Role of imaging in the management of trauma victims. In: Emergency Radiology, 1st ed. Springer: Berlin, Germany; 2002; pp. 3–23. https:// doi.org/10.1007/978-3-540-68908-9_1.
15. Crumley, I., Halton, J., Greig, J., et al. The impact of computed radiography and teleradiology on patients’ diagnosis and treatment in Mweso, the Democratic Republic of Congo. PLoS One. 2020;15(1):e0227773. https://doi.org/10.13 71/journal.pone.0227773.
16. Willett, J.K. Imaging in trauma in limited-resource settings: a literature review. Afr J Emerg Med. 2019;9:S21–S27. https://doi.org/10.1016/j.afjem.2018.07.007.
17. The Committee on Trauma, American College of Surgeons (ACS). ATLS® Advanced Trauma Life Support® Student Course Manual, 10th ed. ACS: Chicago, IL; 2018.
18. Vela, J.H., Wertz, C.I., Onstott, K.L., et al. Trauma imaging: a literature review. Radiol Technol. 2017;88(3):263–276. Available online: https://www.scopus.com/record/displ ay.uri?eid=2-s2.0-85015321421&origin=inward.
19. Aderinto, N. Diagnosing the disparities: an analysis of the current state of medical imaging in Africa and strategies for improvement: a correspondence. Int J Surg Glob Health. 2023;6(3):e138–e138. https://doi.org/10.1097/GH9.000 0000000000138.
20. Driban M., Dissak-Delon F.N, Carvalho M., et al. Failure to receive prescribed imaging is associated with increased early mortality after injury in Cameroon. PLOS Glob Public Health. 2023;3(8):e0001951. https://doi.org/10.1371/jo urnal.pgph.0001951.
21. Frija, G., Blažić, I., Frush, D. et al. How to improve access to medical imaging in low-and middle-income countries. EClinicalMedicine. 2021;38:101034. https://doi.org/10.10 16/j.eclinm.2021.101034.
22. Delamater, P.L. Spatial accessibility in suboptimally configured health care systems: a modified two-step floating catchment area (M2SFCA) metric. Health Place. 2013;24:30–43. https:// doi.org/10.1016/j.healthplace.2013.07.012.
23. Amponsah, S.K., Amoako, G., Darkwah, K.F., et al. Location of ambulance emergency medical service in the Kumasi metropolis, Ghana. Afr J Math Comp Sci Res. 2011;4(1):18–26. Available online: http://www.academicjournals.org/AJMCSR.
24. Kisiała, W., Rącka, I., Suszyńska, K. Population access to hospital emergency departments: the spatial analysis in public health research. Int J Environ Res Public Health. 2022;19(3):1437. https://doi.org/10.3390/ijerph19031437.
25. Blair, K.J., Paladino, L., Shaw, P.L., et al. Surgical and trauma care in low- and middle-income countries: a review of capacity assessments. J Surg Res. 2017;210:139–151. https:// doi.org/10.1016/j.jss.2016.11.005.
26. Shaw, B.I., Wangara, A.A., Wambua, G.M., et al. Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage. Trauma Surg Acute Care Open. 2017;2(1):e000130. https://doi.org/10.1136/tsaco-20 17-000130.
27. Hui, C.M., MacGregor, J.H., Tien, H.C., et al. Radiation dose from initial trauma assessment and resuscitation: review of the literature. Can J Surg. 2009;52(2):147. Available online: https://pmc.ncbi.nlm.nih.gov/articles/PMC2663507/.
28. Khandpur, R.S. Handbook of Biomedical Instrumentation, 3rd ed. Vol. 1. McGraw Hill: New Delhi, India; 2014.
29. Bronzino, J.D. The Biomedical Engineering Handbook, 3rd ed. Taylor and Francis: Connecticut; 2006.
30. Dyro, J.F. Clinical Engineering Handbook, 1st ed. Elsevier: New York, NY; 2004. Available online: https://linkingh ub.elsevier.com/retrieve/pii/B9780122265709X50005.
31. Thippeswamy, P.B., Rajasekaran, R.B. Imaging in polytrauma – principles and current concepts. J Clin Orthop Trauma. 2021;16:106–113. https://doi.org/10.1016/j.jcot.2020 .12.006.
32. Tesfaye Geta, E., Terefa, D.R., Desisa, A.E. Efficiency of Medical Equipment Utilization and Its Associated Factors at Public Referral Hospitals in East Wollega Zone, Oromia Regional State, Ethiopia. Med Devices (Auckl) . 2023;16:37–46. https:// doi.org/10.2147/MDER.S401041.
33. Ghana Statistical Service (GSS). Population and Housing Census: Press Release of Provisional Results, GSS: Accra, Ghana. Available online: https://statsghana.gov.gh/gssma in/fileUpload/pressrelease/2021%20PHC%20Provisional %20Results%20Press%20Release.pdf.
34. Ghana Health Service (GHS). Profile of GHS. Available online: https://ghs.gov.gh/profile-of-ghs/.
35. Bour, B.K., Sosu, E.K., Hasford, F., et al. National inventory of authorized diagnostic imaging equipment in Ghana: data as of September 2020. Pan Afr Med J. 2022;41:301. https:// doi.org/10.11604/pamj.2022.41.301.30635.
36. World Health Organization (WHO). Harmonized Health Facility Assessment (HHFA). Available online: https://www .who.int/data/data-collection-tools/harmonized-health-fa cility-assessment/introduction.
37. Mesic, A., Damsere-Derry J., Feldacker C., et al. Geospatial analysis of injury severity on major roads in Ghana (2017–2020): implications for targeted injury prevention and control initiatives. Inj Prev. 2024;0:1–11. https://doi .org/10.1136/ip-2024-045270.
38. Kabongo, J.M., Nel, S., Pitcher, R.D. Analysis of licensed South African diagnostic imaging equipment. Pan Afr Med J. 2015;22:57. https://doi.org/10.11604/pamj.2015.22 .57.7016.
39. Maboreke, T., Banhwa, J., Pitcher, R.D. An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity. Pan Afr Med J. 2019;34:60. https://doi.org/10.11604/pamj.2019.34.60.18935.
40. Geethanath, S., Vaughan, J.T. Accessible magnetic resonance imaging: a review. J Magnetic Res Imaging. 2019;49:e65–e77. https://doi.org/10.1002/jmri.26638.
41. The Royal College of Radiologists. Clinical Radiology: Major Adult Trauma Radiology Guidance. The Royal College of Radiologists: London; 2024. Available online: https:// www.rcr.ac.uk/media/mbzdxefx/rcr-major-adult-trauma -guidance-2024.pdf.
42. Anazodo, U.C., Ng, J.J., Ehiogu, B., et al. A framework for advancing sustainable magnetic resonance imaging access in Africa. NMR Biomed. 2023;36(3):e4846. https://doi.org /10.1002/nbm.4846.
43. Gathuru, L.M., Elias, G.D.O., Pitcher, R.D. Analysis of registered radiological equipment in Kenya. Pan Afr Med J. 2021;40:205. https://doi.org/10.11604/pamj.2021.40 .205.29570.
44. Ngoya, P.S., Muhogora, W.E., Pitcher, R.D. Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country. Pan Afr Med J. 2016;25:99. https://doi.org/10.11604/pa mj.2016.25.99.9736.
45. Nicholl, J., West, J., Goodacre, S., et al. The relationship between distance to hospital and patient mortality in emergencies: an observational study. Emerg Med J. 2007;24(9):665–668. https://doi.org/10.1136/emj.2007.047654.
46. Ginsburg, A.S., Liddy, Z., Khazaneh, P.T., et al. A survey of barriers and facilitators to ultrasound use in low- and middle-income countries. Sci Rep. 2023;13(1):3322. https:// doi.org/10.1038/s41598-023-30454-w.
47. Kumar, A., Agarwal, H., Gupta, A., et al. Imaging Modalities in Trauma and Emergency—a review. Indian J Surg. 2021;83:42–52. https://doi.org/10.1007/s12262-020 -02346-0.
48. Daily Graphic. Afari Military Hospital to be ready March. Graphic Online. Available online: https://www.graphic .com.gh/news/general-news/ghana-news-afari-military -hospital-to-be-ready-march.html.
49. Ghanaian Times. 100-Bed Obuasi Trauma Hospital takes off after President Akufo-Addo cuts sod. 2021. Available online: https://ghanaiantimes.com.gh/100-bed-obuasi-trauma -hospital-takes-off-after-president-akufo-addo-cuts-sod/.
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