682 - Healthcare provider perspectives on barriers and facilitators in the care of pediatric injury patients at two first sites of care in Northern Tanzania: a qualitative study

Publication Number: 3659.682

Cassidy Huun, University of Utah School of Medicine, Murray, UT, United States; Edwin Joseph. Shewiyo, KCMC University, Kilimanjaro, Kilimanjaro, Tanzania; Itikija Edward. Msuya, Hai District Council, Kilimanjaro, Kilimanjaro, Tanzania; Deusdedith Evarist. Marandu, Hai Hospital, Moshi, Kilimanjaro, Tanzania; Nancy Stewart. Mmary, Mwenge Catholic university, Kilimanjaro, Kilimanjaro, Tanzania; Heather Keenan, University of Utah School of Medicine, Salt Lake City, UT, United States; Jennie L. Hill, University of Utah School of Medicine, Salt Lake City, UT, United States; Joao Ricardo Nickenig Vissoci, Duke University School of Medicine, Durham, NC, United States; Melissa H. Watt, University of Utah, School of Medicine, Population Health Sciences, Salt Lake City, UT, United States; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Blandina Mmbaga,Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Calvin Oswald,Lumumba Regional Referral Hospital, Zanzibar, Tanzania; Rosalia Njau, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Francis Gwasma,Pasua Health Centre, Moshi, Tanzania; Emmanuel Minja, Hai District Hospital, Hai, Tanzania

Background: Pediatric injuries represent a leading cause of death and disability globally, with the highest burden seen in low- and middle-income countries (LMICs). In Tanzania, primary health facilities often serve as the first site of care for injured children, yet they face challenges that limit timely and effective management. Understanding the healthcare workers' perspective on barriers and facilitators of pediatric injury care is critical for improving early assessment, stabilization, and referral processes.

Objective: To explore healthcare providers’ perspectives on barriers, facilitators, and potential interventions to improve pediatric injury care at first site healthcare facilities in Northern Tanzania.

Design/Methods: A qualitative study was conducted to explore healthcare providers’ perspectives at two first sites of care. Four focus group discussions (FGDs) were held at Pasua Health Centre and Hai District Hospital in Northern Tanzania. A total of 31 healthcare providers involved in pediatric injury management participated. Discussions focused on five key domains: pre-hospital decisions to seek care, initial patient assessment, patient stabilization, disposition decision making, and referral processes. Audio recordings were transcribed, translated from Kiswahili to English, coded, and analyzed thematically to identify barriers and proposed interventions across the five key domains.

Results: Pre-hospital delays stemmed from transport constraints, financial barriers, and family decision-making. Within facilities, initial patient assessment and stabilization were hindered by a lack of standardized triage systems, limited pediatric-specific training, and shortages of essential equipment. Disposition and referral challenges included limited communication with higher-level facilities, unreliable transport, and caregiver reluctance due to costs (Table 1). Proposed interventions included community education, the establishment of dedicated referral communication lines, and standardized referral documentation. Anticipated challenges for implementation involved limited resources and variable leadership engagement.

Conclusion(s): Healthcare providers at first sites of care in Northern Tanzania face many barriers to delivering timely pediatric injury care. Targeted interventions—including community education and strengthened communication across referral networks—are essential for improving early stabilization and care coordination for injured children in Tanzania.

Table 1
Table1_PASAbstract_Huunetal.pdfCommon barriers identified across the five key domains of care for pediatric injury patients.