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Background <p>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.</p> Methods <p>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.</p> Results <p>A total of 128 providers responded, primarily orthopaedic surgeons (<i>n</i> = 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 (<i>p</i> &gt; 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, &gt; 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 &gt; 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.</p> Conclusions <p>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.</p>

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Assessing barriers to musculoskeletal trauma care in Ethiopia: a national providers’ survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Samhita Kadiyala,
  • Cameron Geoffrey Almeida,
  • Mengistu G. Mengesha,
  • Ephrem G. Adem,
  • James Berwin,
  • Alpha Seifu Ali,
  • Samuel Hailu,
  • Kiran J. Agarwal-Harding

摘要

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.