Quality of care among traumatic brain injury patients at Mulago National Specialized Hospital, Uganda

Abstract

Background: Traumatic Brain Injury (TBI) is unevenly concentrated in Low to Middle Income Countries with the odds of dying from TBI in Uganda more than 4 times higher than in High Income Countries. Providing quality care services is an essential component of any response to TBI treatment, thus the overall objective of this study was to describe and analyze quality of care among patients with Traumatic Brain Injury at Mulago National Specialized Hospital. Methods: A cross-sectional study design was used employing both quantitative and qualitative data collection methods. Quality of care was measured using Bloom’s cut-off of 80% whereby a core greater or equal to 80% was termed as “good” otherwise it was “poor”. A total of 1,195 observations in the different processes of care for TBI patients were made and 9 Key Informant Interviews (KIIs) with health workers were conducted. Quantitative data were entered into Epidata software and Statistical analyses were performed in Stata version 14 (Stata Corp, College Station, TX). Univariable analyses were performed to obtain proportions for categorical variables. Qualitative data were analyzed using thematic analysis. Results: Overall, quality of care among TBI patients at Mulago National Specialized Hospital Neurosurgical unit was poor (63.0%). Health workers reported different perceptions on factor that affect the quality of care among TBI patients such as inadequate infrastructure, human resource, medicines and equipment and inadequate knowledge and skills. Generally, most of the structural inputs for management of TBI were available and functional when needed and quality of care for TBI patients in terms of the different processes of TBI care varied. Conclusion: Quality of care provided by health workers among TBI patients at Mulago National Specialized Hospital Neurosurgical Unit was poor. Major factors perceived to affect the quality of TBI care at the unit were identified to include inadequate infrastructure, medical equipment, medicines and supplies, human resources, knowledge and skills, and lack of training. Recommendation: Measures to improve the quality of care provided by health workers among TBI patients should be taken focusing on the provision of functional structural inputs, medicines, availing TBI protocol guidelines, conducting refresher courses, and continuous medical education to enhance health workers’ knowledge and skills, design quality improvement strategies targeting TBI care, monitor and supervise health workers involved in providing TBI care to boost the implementation of the set TBI care guidelines.