Challenges to fracture service availability and readiness provided by allopathic and traditional health providers
National surveys across The Gambia and Zimbabwe
Bibliographic Data
Background: Populations in Africa are ageing, hence the number of age-related fragility fractures, including hip fractures, is rising. Hip fractures are an indicator condition for older adult health provision, as they require a multifaceted pathway of care. To enable health service planning, detailed national-level understanding of current fracture service provision is needed. Methods: The WHO Service Availability & Readiness Assessment survey was modified to evaluate fracture service availability, and readiness. All health care facilities to which a patient with a hip fracture could present in The Gambia and Zimbabwe were invited to participate between October 2021 and January 2023. A further traditional bone-setter (TBS)-specific survey assessed TBS care in The Gambia. Availability of services per 100 000 adults ≥ 18 years, and general, fracture-specific, and hip fracture-specific care readiness were determined. Results: All invited facilities in Zimbabwe (n = 186), 98% in The Gambia (n = 150), and 35 of 42 (83%) TBS participated in the survey. General availability of hospital facilities was low in both Zimbabwe and The Gambia and many facilities lacked regular electricity, reliable oxygen supplies, and sharp/infectious waste disposal. In The Gambia, 78.6% public hospitals and 53.8% other facility types (e.g. NGO/mission) had no doctors. Fracture care readiness: < 1 orthopaedic surgeon was available for 100 000 adults in both countries. Orthopaedic trained nurses, physiotherapists, and occupational therapists were few. Only 10 (6.7%) facilities in The Gambia and 56 (30.1%) in Zimbabwe had functioning X-ray facilities. Equipment for fracture immobilisation was widely unavailable. No public facility had a dual-energy X-ray absorptiometry scanner; antiresorptive treatment access was limited to < 5% facilities. Hip fracture readiness: only four facilities in The Gambia and 17 in Zimbabwe could offer surgery. Inpatient delays for surgery were long, especially in Zimbabwe. Non-operative management was common in Zimbabwe and in those visiting TBS in The Gambia. Over half TBS (51.4%) reported being able to set a hip fracture, management included traditional medicines (57.1%), splinting (20.0%), manipulation (14.3%) and traction (5.7%). Only 14.3% TBS referred hip fractures to hospital. Conclusions: Findings highlight multiple important modifiable gaps in care which warrant urgent focus, with recommendations made, given expected increases in fragility fractures and need for universal health coverage
Allopathic medicine · Alternative medicine · Business · Environmental health · Health services · Population · Service provider · Bone health and osteoporosis research · Hip and Femur Fractures · Medicine · Musculoskeletal Disorders and Rehabilitation · Marketing
Understanding factors that impact patient access and engagement with biomedical and traditional care for hip fractures in The Gambia
Traditional bone setter practices and the interaction with biomedical care in the treatment of hip fractures in The Gambia
Hip fracture care in Africa
Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe
| Unique citing works | 4 |
|---|---|
| Citations per year | 4 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 4 |