Access to Trauma Care for Patients With Proximal Femur Fractures in Resource‐Limited Settings: A Prospective Cohort Study in Rural Tanzania

BACKGROUND: The standard of care for proximal femur fractures is internal fixation or arthroplasty within 48 hours after injury. In resource-limited settings, access to surgical services is limited. The aim of this study was to assess access to care for patients with proximal femur fractures in Tanzania by applying the Three Delays framework. METHODS: A prospective cohort study was conducted in a rural regional referral hospital in Tanzania. All patients with a proximal femur fractures admitted between August 2019 and August 2020 were included. Data were collected on patient demographics, pre- and in-hospital care, timelines and affordability. According to the Three Delays framework, delays and reasons for delays in seeking (first delay), reaching (second delay) and receiving care (third delay) were explored using a structured survey. RESULTS: Forty-seven patients were included. Twenty-four patients (51%) delayed in seeking care at a health care facility within 24 hours after injury with a median delay of 13 days (IQR 4-26 days). Ten patients (21%) were delayed in reaching a healthcare facility within 24 hours. Thirteen patients (28%) experienced a delay in receiving initial surgical care. None of the patients were treated according to the international standard. Thirty-eight patients experienced catastrophic expenditure as a result of their hospital admission. CONCLUSION: The majority of patients with a proximal femur fracture experienced a considerable delay in access to care and none of the patients were treated according to international standards. This should be improved by identifying ways to increase the availability of affordable surgical treatment options.