Anjni Joiner, MD

Duke University

“Healthcare Access Barriers and an Evidence Based Solution in a Low-Income Country”
SAEMF/GEMA Research Pilot Grant




It is estimated that 10% of deaths and 16% of all disabilities worldwide are caused by injuries. Transport to and from healthcare facilities can be a major impediment to injury victims receiving care in low-resource settings. Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, sees over 2,000 acute injury patients annually, but little is known of the specific barriers, including transportation, to accessing health facilities for those in the acute phase of an injury or for those who require follow-up care posthospitalization. The goals of this project are to use a holistic approach to evaluate access-to-care barriers in a low- and middle-income country (LMIC) setting and adapt an innovative access solution for injury patients during the post-hospitalization period. The specific aims of this project are to 1) complete a systematic review of transportation and access-to-care solutions employed in other low- and middle-income countries, 2) perform a mixed methods analysis from injury registry data and qualitative data collection from injured patients, and to 3) inform a setting-specific feasibility study of a targeted, posthospitalization access-to-care solution. This proposal will serve as a launching point to leverage additional research and funding on barriers to accessing care, including prehospital care and clinic and hospital transportation in injury patients. By working with an experienced NIH-funded mentor, I will gain further career development and expertise to conduct large-scale mixed methods research studies.

Injuries are time-dependent conditions frequently encountered in emergency medicine and the majority of injury deaths occur in LMICs. We must increase focus on rapid treatment and post-injury care of these patients through the development of prehospital services and ensuring follow-up care of those discharged to reduce morbidity and mortality while maintaining a holistic approach and developing setting-specific interventions. Emergency medicine is uniquely qualified to step into this role.

Research Results

Dr. Joiner is still completing the project.