ArticleBMJ global health2026
Delays in seeking and reaching care for injured patients in four low-income and middle-income countries: a cohort study.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- 'A race against time': a photovoice study on priorities for quality of injury care with patients, health workers and policymakers in four low- and middle-income countries.BMJ global health · 2026Article
- A systems approach to understanding injury care in LMICs using causal loop diagrams.BMJ global health · 2026Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInjury burden is high in low-income and middle-income countries (LMICs). Delays in accessing definitive care after injury beyond the 'golden' hour or 2 hours worsen outcomes. We examined delays in accessing definitive healthcare after injury and whether their magnitude and associations differ across four diverse LMICs: Ghana, Pakistan, Rwanda and South Africa.
methodsAcross 19 hospitals providing definitive care for injuries in urban or rural settings, we enrolled patients with moderate to severe injuries who were hospitalised for at least 12 hours. The time between injury and admission for definitive care and perceived reasons for delays in seeking and reaching care were captured. The association between more than 1-hour delay to reaching definitive care and age, sex, education, wealth, injury mechanism or severity, prior healthcare encounters, ambulance transport, the hospital type and catchment area was evaluated in a multivariable model. Patients' perceived reasons for delay in seeking and reaching care were described. Findings were compared between countries.
resultData on delays were available for 8331 patients, of whom 57.3% experienced delays exceeding 1 hour. Prior healthcare encounter before definitive care showed the strongest association with delay (OR: 8.44, 95% CI 7.41 to 9.60). Delays were associated with older age, less education and wealth, greater injury severity, urban (vs rural) catchment area, ambulance transport, injury mechanism due to falls or fire (vs road traffic collision) and tertiary (vs secondary) hospital admission in the adjusted model. Ghana and Rwanda showed the lowest and highest odds of delays compared with South Africa, respectively. Only 18.8% of patients perceived being delayed, most citing unawareness of urgency and ambulance unavailability as reasons.
conclusionsMost injured patients do not arrive at definitive care within the critical golden hour, with delays inequitably affecting the population. Improvements in pathways to care are needed to reduce delays across healthcare systems.
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