Assessing Barriers to Musculoskeletal Trauma Care in Ethiopia: A Technical Priorities Survey of Providers

Purpose: As the first study of its kind in Ethiopia, we sought to define evidence-based, expert-informed technical priorities for national orthopaedic trauma capacity building. Methods: A scoping review of 80 publications guided the development of essential goals and challenges to orthopaedic trauma care delivery nationwide. This list was refined through in-depth interviews with local orthopedic surgeons, and a survey was distributed to providers nationally through professional networks. Results: 128 respondents, primarily orthopaedic surgeons (n=110). The majority reported inadequate diagnosis (77%), treatment (83%), and rehabilitation (90%) of musculoskeletal pathology. The most common preoperative challenges included inadequate first aid in the prehospital setting (99%), and inadequate triage and referral in primary and secondary hospitals (>70%). At primary hospitals, slings and plaster were scarce (79.8%); at secondary hospitals, surgical implants/instruments (88.9%) and blood products (67.4%) were limited. At tertiary centers >70% reported appropriate operative care, but surgical implants/instruments (75.7%), fluoroscopy (68.9%) and negative pressure wound therapy (78%) were inadequate. Insufficient trauma training was reported at primary (90.9%), secondary (78.3%), and tertiary hospitals (53.3%). Conclusion: Our study identified key targets for musculoskeletal trauma care capacity improvement at every level. Training in trauma care was a key area for improvement, particularly in first aid, triage and referral in pre-hospital settings and primary hospitals, and definitive orthopaedic trauma management at secondary hospitals. At tertiary centers, improving availability of surgical supplies is essential. These evidence-based, expert-guided insights should guide policy priorities and actionable strategies.