**5. Consequences of trauma to rural and semi-urban regions of the LMICs**

their physical abilities. Furthermore, children may not perceive risks of falling and getting injured as adults do. These two facts may account for injuries sustained by children when working in the rural and semi-urban regions. A study from one of the rural areas of Nigeria reports that most children with ocular injuries sustained were injured while working in the farms or playing [55]. Furthermore, children are comparatively vulnerable to physical trauma during dangerous incidents that may happen in their residences. These dangerous incidents are such as a fall of a poorly constructed house, throwing of wreckages during strong winds, earthquakes, and heavy rains. Youths and young adults may manage to escape in such disastrous incidents, while a majority of children fail to do so hence sustaining physical trauma.

**4. Emergency services following trauma in the rural and semi-urban** 

There is evidence that prehospital mortality can be reduced significantly by good emergency services following trauma which includes first aid and timely and safe transport to health facility [56]. In most LMICs reporting and life supporting systems to sustain the injured person and transportation to health facility are unreliable and indeterminate [3, 57]. It is common for injured person in rural and semi-urban regions of LMICs to be handled haphazardly at the trauma scene and transported by laypersons to the health facility by any means possible. For example, in Zambia, a report showed that the majority of injured persons were transported to the hospital by private cars and it was less than 6% who were transported by ambulance after trauma [3]. In this way, there is a significant delay to get to a health facility and increased risk of secondary trauma and mortality. In most cases, an injured person is given what is regarded as "first aid" by laypersons who happened to be at the incident scene. While such effort to save life is with good intention, this could be of more harm than helpful especially when handling delicate cases such as severe visceral, chest, head, and spinal cord injuries. Noting this danger, some programs to train laypersons on assisting and transporting a trauma victim

While training civilians to help trauma victims seems to be the best option for countries where emergency services are immature or unavailable, there are still issues on the package of training and the population coverage. Trauma varies in type, severity, and complexity of management. Even with good training on basic life support to laypersons, it would be difficult to major life threatening injuries such as those involving head, pelvis, and multiple viscera. Another limitation is that such training of skills requires practical session which may not be that feasible to a big group of learners (population). Furthermore, basic tools and equipment necessary for evacuation, first aid, and transportation of injured person are normally not readily available to complement the acquired knowledge and skills. For this reason, there ought to be a political will to facilitate not only the acquisition of basic knowledge and skills to manage a trauma victim, but also sustainable provision of basic tools for such a task. One useful approach would be inclusion of such information and skills training in school curriculums simultaneously with provision of practical tools. This will to create awareness and orient children with skills for safe handling of an injured person at basic level. This also means that

**regions of the LMICs**

74 Current Issues in Global Health

have yielded convincing results [3, 58].

Rural and semi-urban regions of the LMICs are predominantly inhabited by the poorest of the world population. In general terms, poverty instigates risky activities and poor environmental and occupational safety standards leading to trauma and the resulting disability is also associated to future poverty, hence a vicious cycle [59]. For this reason, any financial-demanding preventive, curative, or rehabilitative strategies against trauma and its consequences are severely limited. Although there is scarcity of reports on trauma-related health costs from LMICs, it is generally apprehended that such cost is unbearably high to this population [59, 60]. Consequently, persons who sustains trauma in these regions either dies (before or immediately on arriving to the health facility) due to a lack of emergency and life support services or remains with irreversible disability. It is "lucky" for a seriously injured person from these regions to survive without any residual significant impairment. Inadequacy in evacuation, transportation, and timely management of trauma casualties are factors prehospital mortality, secondary injury, and disability which could otherwise have been avoided.

The cost associated with trauma-related disability in these regions is rarely researched, but it is an irrefutable fact that they are common and costly in these regions. Reporting in the bulletin of the World Health Organization, Gosselin and colleagues refers to injuries as a neglected burden in LMICs [60]. It is indeed forgotten as very few projects on trauma are carried out and or published from these regions. When matched against country-specific gross domestic product (GDP) trauma in the rural and semi-urban regions of the LMICs are astronomically costly. It is estimated that most countries in the LMICs spend between 1.1 and 2.9 of their Gross Domestic Product (GDP) to trauma due to RTAs alone [61, 62]. In Thailand, it was estimated that for 10 years, more than 5 billion dollars had been used due to RTAs-related trauma [63]. Trauma also induces a significant straining on the already resource-constrained health system individual and immediate family.

In these regions, there are hardly any published estimates of social costs due to trauma including those resulting from other causes such as falls, burn, and assaults. However, it is known that most developing countries lack basic social security system from which a person who incurs trauma can be supported to attain healthcare and rehabilitation services accordingly. This means that the whole treatment cost for someone with significant trauma is left to the individual and immediate family. It follows that if the injured person and immediate family are financially unstable there is a failure in affording necessary health and rehabilitation services. Even in countries where there may be exemption (after thorough social assessment) for persons who cannot afford hospital bill, the challenge remains on getting to and being admitted in such hospital in the first place. A recent study in Uganda reported that among the difficulties faced by individuals with trauma included inability to attain and afford transport to the hospital and pay for treatments. For this reason, they had to rely on social support from close relatives and friends [64].

of permanent disability is the end outcome is very costly. Such cost is incurred by the injured individual with his or her immediate family. There are also continuous disability-related health and rehabilitation cost such as function and mobility assistive devices which are also left to families to meet. Being a poor setting, most disabled persons and their families struggle to meet the entailed cost. As a result, a majority of disabled persons in these regions lack appropriate devices to enable their functioning. As a result, they end up being almost always dependent on others socioeconomically and in activities of daily living. This state lowers the quality of life

Physical Trauma and Its Consequences in Rural and Semi-Urban Regions of Low and Middle…

http://dx.doi.org/10.5772/intechopen.79545

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1 Kilimanjaro Christian Medical Center, Faculty of Rehabilitation Medicine – Physiotherapy,

[1] Beyene TJ et al. Determinants of health seeking behaviour following rabies exposure in

[2] Hoque MF et al. Cervical spinal cord injury due to fall while carrying heavy load on

[3] Mowafi H et al. Analysis of prehospital transport use for trauma patients in Lusaka,

[4] Diamond MB et al. Prevalence and risk factor for injury in sub-Saharan Africa: A multi-

[5] Ul Baset MK et al. Pattern of road traffic injuries in rural Bangladesh: Burden estimates and risk factors. International Journal of Environmental Research and Public Health.

[6] Zimmerman K et al. Road traffic injury on rural roads in Tanzania: Measuring the effectiveness of a road safety program. Traffic Injury Prevention. 2015;**16**(5):456-460

[7] Boniface R et al. Factors associated with road traffic injuries in Tanzania. The Pan African

[8] Reardon JM et al. The epidemiology and hotspots of road traffic injuries in Moshi,

2 Faculty of Medicine, Department of Community Medicine and Rehabilitation –

Ethiopia. Zoonoses and Public Health. 2018;**65**(4):443-453

Zambia. World Journal of Surgery. 2016;**40**(12):2868-2874

country study. Injury Prevention. 2018;**24**(4):272-278

head: A problem in Bangladesh. Spinal Cord. 2012;**50**(4):275-277

Tanzania: An observational study. Injury. 2017;**48**(7):1363-1370

and increases poverty levels to persons with disability and their families.

\*Address all correspondence to: luluwayesu@gmail.com

Physiotherapy, Umea University, Sweden

**Author details**

Moshi, Tanzania

**References**

2017;**14**(11):1-28

Medical Journal. 2016;**23**:46

Haleluya Imanueli Moshi1,2\*

Injuries resulting from traumatic forces may recover fully or leave the individual with either a temporary or permanent disability. Of these three possible outcomes, permanent disability is most costly to the individual and immediate family. This cost is due to the fact that persons with permanent disability require health-sustaining and rehabilitation services including assistive devices throughout life. Such devices are necessary for them to carry out activities of daily living, pursue a career, and engage in their communities. Essential assistive devices range from relatively affordable hand sprints (for activities of daily living) to more expensive wheelchairs which are a prerequisite for mobility and function. Majority of individuals with severely lower limbs impairments such as total paralysis are left with no other means of mobility except a wheelchair. Unfortunately, essential assistive devices are either unavailable or unaffordable in most rural and semi-urban inhabitants of the LMICs. Again, the burden affording assistive devices is also left to the person and/or immediate family who (in most cases) cannot cover the entailed cost [65]. As a result, a majority of disabled persons lack assistive devices or obtain inappropriate one as a donation. Lacking appropriate functional and mobility device leaves the disabled person in a state of dependence in various aspects. Dependence that results from lack of assistive devices adds to the perceived severity of disability [66]. This disability culminates poverty to the person and affects the whole family particularly the dependents.
