706 Inequalities in injury prevalence and the availability of emergency care: a multi-country district-level analysis of the demographic health surveys

Background Injuries are a leading cause of morbidity and mortality, accounting for an estimated 520 million injuries and 4.5 million deaths annually. Despite mortality reductions in the past three decades, substantial regional, national, and sub-national disparities persist, with nearly 90% of deaths occurring in low- and middle-income countries (LMICs). One of the key contributing factors to this burden is inadequate access to pre-hospital and emergency care in LMICs. A study of African countries found that 29% of people were located more than 2 hours from the nearest facility, falling short of the global standard. This is despite projections indicating that access to appropriate and timely emergency services would led to a 36% reduction in disability and a 45% reduction in mortality in LMICs. Objective We aimed to assess the spatial distribution of injuries and emergency care services in three LMICs (Kenya, Nepal, and Uganda) using Demographic Health Survey data at the household and facility-level. Methods We descriptively report the prevalence of road traffic and other-cause (e.g., violence) injuries by sex, age, and type, on a district-level. We use the Service Provision Assessment to classify facilities into four categories: Level A (facilities with 24-hour emergency services), Level B (facilities with resuscitative capabilities), Level C (tertiary care facilities), and Level X (facilities with insufficient emergency care capacity). In an exploratory analysis, we also assess the location of conflict deaths in relation to emergency care capacity. Results and Conclusion This study seeks to shed light on the distribution of injuries and emergency care services, recognizing the critical role they play in addressing this global health challenge. Through our analysis of data from Kenya, Nepal, and Uganda, we aim to provide insights that can guide more effective allocation of emergency care resources, ultimately contributing to improved health outcomes and reduced mortality rates in these regions.