Impact of Capacity Building of Healthcare Workers on Management of Post-Traumatic Stress Disorder Among Road Traffic Injury Patients in Hospitals in Fako Division, Cameroon

Abstract Background: Road traffic injuries (RTIs) are a major global public health concern, often leading to serious physical and psychological consequences, including post-traumatic stress disorder (PTSD), a prevalent and debilitating psychiatric disorder following RTIs. About 22.2% of RTI victims develop PTSD worldwide and several factors have been associated with PTSD in RTI. Victims of RTIs frequently present to primary care, however PTSD in RTI patients remain under-explored in low and middle income (LMIC) settings like Cameroon and there is no standardized practice on the routine screening of PTSD among RTI. Late identification of PTSD and/or poor management could become fatal to health system. Timely management is the most viable way of closing the gap. Objectives: Study aims to evaluate the impact of capacity building of Health care workers on management of PTSD among RTI patients in Health Facilities (HFs) in Fako. Materials and methods: A hospital and community-based intervention study will be conducted at three purposefully selected hospitals in Fako Division, Cameroon: Buea Regional Hospital, Saint Luke Hospital Buea, and Limbe Regional Hospital. These hospitals are selected because of the frequency of RTI patients visiting the hospitals. Buea Regional Hospital was selected as the intervention group via simple random sampling. Using a sequential design, the study included; a hospital chart review aimed at establishing the epidemiological profile of RTI over 5 years (2019-2023), cross sectional study aimed at determining the prevalence and factors associated with PTSD (January 2023 to June 2024), and exploratory study (in-depth interviews and cross sectional study) aimed at assessing care given to RTI patients and identify gaps in PTSD care and barriers to PTSD management. The intervention will consist of capacity building of healthcare workers on management of PTSD in RTI victims with pre/posttest used for evaluation, and the use of psychotherapy in a pre/post quasi experimental study without a control group for 89 selected patients that will be diagnosed with PTSD aimed at improving patients' outcome (PTSD score/status). Consenting adult RTI survivors, aged 18years and above will be recruited and standardized DSM-5 PTSD checklist will be used for PTSD diagnosis. Qualitative data will be analyzed using thematic approach and quantitative data inputted into kobo toolbox and analyzed in SPSS using descriptive statistics and binary logistic regression at 5% level of significance. Expected outcomes: Consist of the epidemiological profile of RTI patients, RTI trends over 5years, prevalence and factors associated with PTSD in RTI, standard of care given to RTI patients particularly regarding PTSD care in RTI victims by HCWs, barriers to PTSD management. The impact of capacity building of HCWs on PTSD management; change in knowledge and comfort level in PTSD screening, and management by HCWs. Number of RTI patients screened for PTSD by trained HCWs during 6 months post-training follow-up, number of timely referrals of PTSD cases identified, and PTSD patients' PTSD score/status (outcomes) at 1,3,and 6 months follow-up with psychotherapy. This study will improve patients' outcomes and provide evidence for in-hospital care quality improvement, inform policy and practice.

INTRODUCTION 1.1 Background to the Study Post-traumatic stress disorder (PTSD), a serious mental health condition triggered by traumatic events such as road traffic injuries (RTIs), represents a significant yet often overlooked consequence of RTIs, adding a substantial mental health burden to the already significant physical trauma. While RTIs are recognized as a major global public health challenge, the psychological impact on survivors, particularly the development of PTSD, often remains underreported and undertreated, especially in low- and middle-income countries (LMICs) like Cameroon. To address this critical gap in care, there is a pressing need to build the capacity of healthcare workers (HCWs) in Fako Division- Cameroon to effectively screen for, diagnose, and manage PTSD among RTI patients, thereby facilitating holistic recovery and improving patients' outcomes.

Road traffic Injuries are a significant global public health problem and a leading cause of morbidity, mortality, and disability, disproportionately affecting low- and middle-income countries (LMICs) where over 93% of the world's RTI-related fatalities occur. Organized trauma care systems have been shown to save lives and reduce morbidity. Globally, RTIs result in about 1.35 million deaths annually, with 20-50 million sustaining severe injuries. Reports from WHO in 2022 indicate that road traffic crashes (RTCs) cost most countries 3% of the gross domestic product (GDP), with the highest rates of RTI recorded in the African region.

Beyond the fatal consequences, RTIs also cause significant morbidity with social, professional, economic, physical, and psychological consequences, with post-traumatic stress disorder (PTSD) being a prevalent and debilitating mental health issues. Road traffic injury (RTI) is one of the principal causes of PTSD, ranking third after sexual and physical assaults. The World Health Organization (WHO) recognizes mental health as an integral component of overall well-being, and has identified PTSD as a significant public health concern, including PTSD in the priority conditions covered by WHO's mental health Gap Action Programme (mhGAP), which includes guidelines for managing PTSD, emphasizing the need for comprehensive care, especially in LMICs. PTSD is diagnosed using the PTSD checklist-5 (DSM-5) and is characterized by intrusive recollections, avoidance behaviors, negative alterations in cognition and mood, and hyper arousal, which can profoundly impair an individual's ability to function, reintegrate into society, and lead a fulfilling life.

Studies consistently demonstrate a significant prevalence of PTSD among RTI survivors globally. Recent meta-analysis and systematic review suggests that the global prevalence of PTSD among RTI survivors ranges from 6.3% to 58.3% with a pooled prevalence of 22.2%, varying based on factors such as population characteristics, time elapsed since the injury, and assessment methodologies. Prior research across Africa consistently reveals a substantial burden of PTSD, with pooled prevalence estimates reaching 26% ranging from 8% to over 61%, underscoring the substantial psychological burden associated with RTIs. Untreated PTSD can profoundly impair an individual's ability to function, reintegrate into society, and maintain overall well-being, thereby leading to substantial personal suffering and escalating societal costs. All demographics are indiscriminately affected by PTSD, and several factors have been associated with the development of PTSD in RTI.