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Assessing barriers to musculoskeletal trauma care in Ethiopia: a national providers' survey
Samhita Kadiyala1, Cameron Geoffrey Almeida1,2, Mengistu G Mengesha3,4
1Harvard Global Orthopaedics Collaborative, Harvard Medical School, Boston, MA, USA.
Background:
Musculoskeletal trauma represents a major burden in Ethiopia, yet system level barriers to effective care remain poorly studied. This study aimed to identify evidence-based, expert-informed priorities for national orthopaedic capacity building in Ethiopia.
Methods:
A scoping literature review guided the development of essential goals and challenges to musculoskeletal trauma care delivery in Ethiopia. These domains were refined through in-depth interviews with orthopaedic surgeons at tertiary hospitals. A structured survey was then distributed to providers and public health workers nationally through professional networks. Descriptive statistics were used to summarize responses and regional comparisons were performed.
Results:
A total of 128 providers responded, primarily orthopaedic surgeons (n = 110) representing 8 of 14 regions. Most respondents reported managing tibiofibular fracture (92%), femoral shaft fracture (87%), and chronic bone infections (67%) on a weekly basis. Inadequate diagnosis (77%), treatment (83%), and rehabilitation (90%) were widely reported, with no significant regional variation (p > 0.05). In the prehospital setting, inadequate first aid (99%) and delayed triage and referral (96%) were the leading barriers. At primary and secondary hospitals, > 70% reported inadequate triage and referral. Access to slings and plaster for immobilization was inadequate (79%) in primary hospitals; surgical implants/instruments (89%) and blood products (67%) were lacking at secondary hospitals. Though > 70% of respondents reported appropriate and safe operative care delivery at tertiary centers, inadequate implants/instruments (76%), fluoroscopy (69%), and resources for managing bone (67%) and soft tissue defects (51%) were commonly reported. Negative Pressure Wound Therapy was frequently unavailable at secondary (81%) and tertiary (78%) hospitals. Insufficient trauma training was reported across all levels, most notably at primary (91%), and secondary (78%) hospitals.
Conclusions:
Our study suggests significant gaps in musculoskeletal trauma care delivery in Ethiopia. Key priorities should include strengthening prehospital care and triage/referral systems, improving access to essential surgical resources, and expanding system-wide trauma training. These findings provide actionable evidence to guide policy priorities and national strategies in orthopaedic trauma systems development.
