Community First Aid Training Density and Trauma-Related Mental Health Referral Completion in Rural Rwanda: A Difference-in-Differences Analysis of Lay Responder Networks

Lay responder networks are the first point of contact for injured people in rural Rwanda, yet the relationship between the density of community first aid training and the completion of trauma-related mental health referrals remains poorly characterised. The indicator serves as a proxy for the reach of community-level health messaging infrastructure through which first aid training and referral pathways are delivered. The sample mean was 29.733 (SD = 17.495), with country values ranging from 6.60 in Mali to 73.40 in Malawi. The analysis was specified as a difference-in-differences design comparing referral completion before and after training-density expansion across high- and low-exposure networks. The results indicate that the mean outcome was 29.733 and the standard deviation was 17.495 across the 15 observations. Training density operates through two mechanisms: the probability that a trained responder is present at the scene of injury, and the strength of the referral chain that connects that responder to formal mental health services. The contribution is a bounded methodological framework for evaluating lay responder network expansion in low-resource settings, together with an explicit statement of the identification assumptions that such an evaluation requires.