TY - JOUR
T1 - Delays in seeking and reaching care for injured patients in four low-income and middle-income countries
T2 - a cohort study
AU - The Equi-Injury Group
AU - The Equi-Injury Group
AU - Ghalichi, Leila
AU - Davies, Justine
AU - Chu, Kathryn
AU - Razzak, Junaid
AU - D’Ambruoso, Lucia
AU - Ignatowicz, Agnieszka
AU - Amberbir, Alemayehu
AU - Sitch, Alice
AU - Mann, Mia
AU - Whitaker, John
AU - Ghalichi, Leila
AU - MacQuene, Tamlyn
AU - Berhe, Derbew Fikadu
AU - Nzungize, Lambert
AU - Agbeko, Anita Eseenam
AU - Osei, Richard
AU - Wajidali, Zabin
AU - Atiq, Huba
AU - Nodo, Olwethu
AU - Laurenzi, Christina
AU - Twizeyimana, Eric
AU - Mugisha, Nadine
AU - Nzasabimana, Pascal
AU - Dramani, Adams
AU - Konadu-Yeboah, Dominic
AU - Amofa, Ebenezer Kwame
AU - Bukari, Mohammed
AU - Rahim, Komal Abdul
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
PY - 2026/3
Y1 - 2026/3
N2 - BackgroundInjury burden is high in low-income and middle-income countries (LMICs). Delays in accessing definitive care after injury beyond the ‘golden’ hour or 2 hours worsen outcomes. We examined delays in accessing definitive healthcare after injury and whether their magnitude and associations differ across four diverse LMICs: Ghana, Pakistan, Rwanda and South Africa.MethodsAcross 19 hospitals providing definitive care for injuries in urban or rural settings, we enrolled patients with moderate to severe injuries who were hospitalised for at least 12 hours. The time between injury and admission for definitive care and perceived reasons for delays in seeking and reaching care were captured. The association between more than 1-hour delay to reaching definitive care and age, sex, education, wealth, injury mechanism or severity, prior healthcare encounters, ambulance transport, the hospital type and catchment area was evaluated in a multivariable model. Patients’ perceived reasons for delay in seeking and reaching care were described. Findings were compared between countries.ResultData on delays were available for 8331 patients, of whom 57.3% experienced delays exceeding 1 hour. Prior healthcare encounter before definitive care showed the strongest association with delay (OR: 8.44, 95% CI 7.41 to 9.60). Delays were associated with older age, less education and wealth, greater injury severity, urban (vs rural) catchment area, ambulance transport, injury mechanism due to falls or fire (vs road traffic collision) and tertiary (vs secondary) hospital admission in the adjusted model. Ghana and Rwanda showed the lowest and highest odds of delays compared with South Africa, respectively. Only 18.8% of patients perceived being delayed, most citing unawareness of urgency and ambulance unavailability as reasons.ConclusionsMost injured patients do not arrive at definitive care within the critical golden hour, with delays inequitably affecting the population. Improvements in pathways to care are needed to reduce delays across healthcare systems.
AB - BackgroundInjury burden is high in low-income and middle-income countries (LMICs). Delays in accessing definitive care after injury beyond the ‘golden’ hour or 2 hours worsen outcomes. We examined delays in accessing definitive healthcare after injury and whether their magnitude and associations differ across four diverse LMICs: Ghana, Pakistan, Rwanda and South Africa.MethodsAcross 19 hospitals providing definitive care for injuries in urban or rural settings, we enrolled patients with moderate to severe injuries who were hospitalised for at least 12 hours. The time between injury and admission for definitive care and perceived reasons for delays in seeking and reaching care were captured. The association between more than 1-hour delay to reaching definitive care and age, sex, education, wealth, injury mechanism or severity, prior healthcare encounters, ambulance transport, the hospital type and catchment area was evaluated in a multivariable model. Patients’ perceived reasons for delay in seeking and reaching care were described. Findings were compared between countries.ResultData on delays were available for 8331 patients, of whom 57.3% experienced delays exceeding 1 hour. Prior healthcare encounter before definitive care showed the strongest association with delay (OR: 8.44, 95% CI 7.41 to 9.60). Delays were associated with older age, less education and wealth, greater injury severity, urban (vs rural) catchment area, ambulance transport, injury mechanism due to falls or fire (vs road traffic collision) and tertiary (vs secondary) hospital admission in the adjusted model. Ghana and Rwanda showed the lowest and highest odds of delays compared with South Africa, respectively. Only 18.8% of patients perceived being delayed, most citing unawareness of urgency and ambulance unavailability as reasons.ConclusionsMost injured patients do not arrive at definitive care within the critical golden hour, with delays inequitably affecting the population. Improvements in pathways to care are needed to reduce delays across healthcare systems.
KW - Injury
UR - https://www.scopus.com/pages/publications/105034351937
U2 - 10.1136/bmjgh-2025-021659
DO - 10.1136/bmjgh-2025-021659
M3 - Article
AN - SCOPUS:105034351937
SN - 2059-7908
VL - 11
JO - BMJ Global Health
JF - BMJ Global Health
IS - 3
ER -
SDG 3 Good Health and Well-being