Knowledge, Attitude and Practice of Advanced Trauma Life Support Principles Among Health Care Workers in Accident and Emergency Departments in Nairobi, Kenya: a Multi-center Study

Abstract

Background: According to the World Health Organization, traumatic injuries are among the leading contributors to death globally, with ninety percent of the injuries approximated to occur in LMICs. The Global Burden of Disease study in 2017 estimates a 26.0% upsurge in road and traffic-related incidences by the year 2030. As a country, we lack information on the practice of ATLS amongst health care workers, especially in the Accident and Emergency departments, where most injuries are noted to be present. Kenya has no standardized system of trauma care. It could be indicated that the high cost of ATLS training locally (USD 335) and limited training facilities (3 partner institutions) and faculty negatively impact ATLS teaching in LMICs such as Kenya. Objectives: To determine the knowledge, attitude, and practice of ATLS principles among health care workers in accident and emergency departments of select Level 5 and 6 hospitals in Nairobi- Kenya Methodology: Descriptive cross-sectional study was conducted at five urban centers within Nairobi, namely, Kenyatta National Hospital, Mbagathi Hospital, Aga Khan Uni-versity Hospital, Mama Lucy Kibaki Hospital, Mater Misericordiae Hospital. Stratified proportionate sampling of 384 study participants from the proposed sites of study was carried out. The participants are nurses and doctors working at the Accident and Emergency units. Study participants were interrogated through a semi-structured questionnaire on knowledge, attitude, and practices of ATLS as well as demographic and training levels. Results: In this study, 202 participants with a mean age of 30.8 and standard deviation of 2.8 were included, with 58.9% male and 41.1% female participants. There were more 62doctors (59%) than nurses (41%), and registrars were the majority among doctors. 84% of participants rated their ATLS knowledge as average. Younger participants and doctors were more knowledgeable about ATLS principles (p<0.001), while nurses and older practitioners were less proficient on ATLS principles and notably less adherent to these principles in practice (p<0.019 and p<0.001, respectively). Registrars were more knowledgeable about ATLS compared to MOs and interns (p=0.004). Most HCWs were welcoming to the idea of ATLS knowledge and practice. However, up to 62% of the respondents had not undertaken ATLS training citing unfavorable cost of the training and lack of time to undertake the training as the most common hinderances. Conclusion: This study highlights the level of knowledge of ATLS principles as deficient amongst majority of the study participants and most notably amongst older participants and nurses. It was also noted that there’s deficiency of practice of ATLS principles amongst majority of the study. Additionally, there’s a positive attitude towards ATLS principles amongst the participants. The findings underscore cost of training as the most important limiting factor to training on ATLS. It was noted that there’s a lack of CMEs on ATLS and on-site simulations on trauma management. Recommendation: As traumatic injuries are a significant contributor to global mortality rates, investing in ATLS training can reduce the burden of injuries locally, regionally as well as globally