Traditional bone setting and trauma care in South-Eastern Chad.

Background: Traditional bonesetters are the main providers of fracture treatment and trauma care in much of Africa. However, there is a paucity of literature on bonesetters in Chad. Objectives: Our study sought to investigate Chadian bonesetter practices, their relationship to the community, and the complex local perspectives on trauma care in Am Timan, Chad. Methods: Thirty-three semi-structured interviews were conducted with community members, traditional bonesetters, and physicians in Am Timan using a constructivist grounded theory approach. Responses were coded, categorized, and compared within and across study populations to identify themes. Results: Most community members (n=25) interviewed preferred bonesetters for trauma care due to their affordability, continuity and convenience of care, and the community's fear of Western medical practices. Although the Chadian bonesetters' fracture management mirrored bonesetters in neighboring African countries, the Chadian bonesetters have a much wider scope of practice, including treatment for both medical and spiritual ailments. Both Jabari (n=6) and physicians (n=2) emphasized the need for more training and collaboration. Conclusion: As in much of Africa, bonesetters perform a major role in providing trauma care in Chad. Our research identifies an opportunity to maximize trauma care in Chad through dialogue, training, and collaboration between bonesetters and physicians.

Discovery of a Hidden Schistosomiasis Endemic in the Salamat Region of Chad, Africa.

There is currently a severe paucity of rural epidemiologic data on urogenital schistosomiasis in the Republic of Chad in north-central Africa that is hindering national control strategies. Our study describes a mobile medical team's 4-year effort to collect data and provide mass therapeutic and preventive chemotherapy in the Salamat Region of Chad, a previously uninvestigated rural area. To overcome severe limitations in time, resources, support, and infrastructure, the team employed several time- and cost-saving techniques that included: (1) traveling by request and referral to utilize local knowledge to find the areas of highest need, (2) conducting convenience sampling for screening, (3) using simple but validated tools to expedite treatment and data gathering, and (4) working within cultural contexts to find and treat the most school-age children possible. The team managed a total of 11,832 patient encounters and found a 55% rate of hematuria (n=6,495) among school-age children, roughly double previous estimates. Rates of hematuria were higher in males (61%, n=3,955/6,466) than females (48%, n=2,301/4,806) and among adolescents (> 65% in all age groups aged 10 years and older). These methods outline an efficient and effective strategy implemented under real-world conditions to enact therapeutic and preventive chemotherapy campaigns in resource-limited settings by engaging village leadership and developing locally driven solutions. Our data highlight the need for continued local epidemiologic efforts to treat the substantial number of children severely affected with schistosomiasis.

Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program.

INTRODUCTION: The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs. STUDY OBJECTIVE: A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs. METHODS: An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar's Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results. RESULTS: A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses. CONCLUSION: Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

Emergency department reliance: a discriminatory measure of frequent emergency department users.

OBJECTIVE: High emergency department (ED) use has previously been defined as a person's having a large number of ED visits, implying that all frequent users are the same. ED reliance (EDR), the percentage of all health care visits that occur in the ED, considers ED use in relation to primary care use and, thus, may discriminate among high-ED-user populations. Our objective was to determine whether EDR, as a complementary use measure, could differentiate frequent users secondary to increased need for care from those with access issues. METHODS: We conducted an analysis of prospectively collected data from the Medical Expenditure Panel Survey from 2000-2001 and 2001-2002. Frequent ED users were defined as having >or=2 ED visits, and EDR was dichotomized as high (>0.33) or low (