Observational studyBMJ open2019
External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study.
Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments.BMJ global health · 2021Pooled it
- Quality improvement in emergency units in low resource settings: a qualitative assessment for understanding challenges and delivering solutions.BMJ open quality · 2026Article
- A systems approach to understanding injury care in LMICs using causal loop diagrams.BMJ global health · 2026Article
- Classroom to crisis: Exploring nursing students' preparedness for emergency unit placements in the Western Cape.Curationis · 2026Article
- Association between health system navigation factors and preventable trauma mortality in Western Cape, South Africa.International journal of emergency medicine · 2026Article
- Delays in seeking and reaching care for injured patients in four low-income and middle-income countries: a cohort study.BMJ global health · 2026Article
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- What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review.World journal of surgery · 2025Article
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- Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors.BMJ global health · 2025Article
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- Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise.BMJ open · 2024Article
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- Equitable access to quality injury care; Equi-Injury project protocol for prioritizing interventions in four low- or middle-income countries: a mixed method study.BMC health services research · 2024Article
- Access to quality care after injury in Northern Malawi: results of a household survey.BMC health services research · 2024Article
- Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.PLoS medicine · 2024Article
- Resuming work roles after injury in a low-income context: Multiple factors influencing the return to work outcomes.PloS one · 2024Article
- Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories.PLOS global public health · 2024Article
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Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveInjury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.
settingAgincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.
participantsAgincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.
methodsA literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the 'three delays framework' (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs-a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.
resultsUsing VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.
conclusionsA substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.
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