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Effectiveness of a Basic Bleeding Control Course for Public Transit Drivers in Dar es Salaam, Tanzania
Josh Drake*1, Fredirick Mashili2, George Kiwango2, Deus Kitapondya2, Sean Kivlehan1
1Emergency Health Systems, Harvard Humanitarian Initiative, Boston, MA; 2Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of


Objectives: To ascertain the effectiveness of a hemorrhage control course among a cohort of public transit motorcycle drivers in Dar es Salaam, Tanzania. A second objective was to characterize participant's interventions among road traffic crash victims in the field. Design: Before-after intervention study, 3-month follow-up. Setting: General community. Participants: 187 participants selected by convenience sampling. Trained all drivers approached. Eligibility criteria: >18 years of age, cellphone, government issued ID. 25 participants lost to follow-up. Intervention: Participants trained in hemorrhage control, equipped with a first aid kit. Main Outcome Measures: The primary outcomes were perceived bleeding control knowledge, perceived ability to apply bleeding control skills, and intention to intervene on behalf of an injured stranger. Participants were surveyed before, immediately after, and three months after training. Data were measured on a 1-5 Likert scale. To characterize interventions among road traffic crash victims in the field, participants were surveyed at the end of each month, providing information on incident locations, severity of bleeding, skills used, transportation to healthcare facilities, and handoff of care. Results: The mean perceived knowledge score increased from 1.70, 95% CI (1.55, 1.85), SD = 0.95 before the training to 4.67, 95% CI (4.55, 4.78), SD = 0.73, p<0.0000 immediately after training, and was sustained three months after training at 4.69, 95% CI (4.61, 4.77), SD = 0.50, p<0.0000. The mean perceived ability to apply bleeding control skills increased from 2.12, 95% CI (1.96, 2.27), SD = 1.01 before training to 4.68, 95% CI (4.59, 4.78), SD = 0.61, p<0.0000 immediately after training, and was sustained three months after training at 4.67, 95% CI (4.57, 4.76), SD = 0.57, p<0.0000. The mean intention to intervene on behalf of an injured stranger increased from 2.69, 95% CI (2.47, 2.92), SD = 1.41 before training to 4.66, 95% CI (4.55, 4.76), SD = 0.65, p<0.0000 immediately after training, and was sustained three months after training at 4.57, 95% CI (4.48, 4.67), SD = 0.57, p<0.0000. Overall, 83 participants provided hemorrhage control interventions in the field. 38 incidents were reported as life-threatening bleeding. Direct pressure was the most frequently applied skill (n=55). Participants transported the injured to healthcare facilities 58 times. Care was transferred to a doctor or nurse 39 times and to a police officer 18 times. Conclusions: This hemorrhage control course increased participant"ôs perceived bleeding control knowledge, ability to apply bleeding control skills, and intention to intervene on behalf of strangers injured in road traffic crashes. In the field, participants demonstrated proficiency in hemorrhage control, transportation of the injured, and handoff of care. Bodaboda show promising ability to effectively learn and provide hemorrhage control interventions following road traffic crashes.

Field Intervention Characteristics
Characteristics No (%)
Total interventions 83 (100)
Incident location by district (n=81)Ilala31 (37.4)
 Kinondoni21 (25.3)
 Temeke16 (19.3)
 Ubungo10 (12.1)
 Other3 (3.6)
Severity of bleeding (n=75)Life-threatening38 (45.8)
 Non life-threatening37 (44.6)
Skills used (n=79)Direct pressure55 (66.3)
 Tourniquet to an arm or leg41 (49.4)
Transport of the injured (n=78)Yes58 (69.9)
 No20 (24.1)
Destination of transport (n=55)Hospital21 (25.3)
 Health Center24 (28.9)
 Village Health Center10 (12.1)
Handoff of care (n=72)Doctor or nurse39 (47.0)
 Other healthcare professional7 (8.4)
 Police officer18 (21.7)
 Someone else6 (7.2)
 Nobody2 (2.4)


Mean Difference in Scores Before Vs. Immediately After Training and Before Vs. Three Months After Training
Mean Difference in Scores Before Vs. Immediately After Training       
 nMean 1Mean 2difSt Errt valuep value
Perceived bleeding control knowledge1611.7024.6712.9690.09929.950.0000
Perceived ability to apply bleeding control skills1612.1184.6832.5650.92527.800.0000
Intention to intervene on behalf of an injured stranger1572.6944.6561.9620.12115.250.0000
        
Mean Difference in Scores Before Vs. Three Months After Training       
 nMean 1Mean 3difSt Errt valuep value
Perceived bleeding control knowledge1371.7664.6932.9270.09530.710.0000
Perceived ability to apply bleeding control skills1382.1674.6672.5000.09326.630.0000
Intention to intervene on behalf of an injured stranger1382.7754.5721.7970.12714.160.0000

Here, Dr. Deus Kitapondya, an ER doctor at the Muhimbili National Hospital in Dar es Salaam, demonstrates bleeding control skills to attentive drivers from a local taxi stand.
Members of a larger taxi stand in Dar es Salaam undergo the basic bleeding control course while a national news agency films the action - a segment which later aired on CGTN Africa, reaching a global audience across Africa, Asia, and the Middle East.


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