Modern conflicts are characterized by wide-spread use of conventional explosive ordnance (EO), improvised explosive devices (IEDs), and other air-launched explosives. In contrast to advances in military medicine and high-income civilian trauma systems since the United States-led wars in Afghanistan and Iraq, the mortality rate among civilian EO casualties has not decreased in decades. Although humanitarian mine action (HMA) stakeholders have extensive presence and medical capabilities in EO-affected settings, coordination between HMA and health actors has not been leveraged systematically.

Data from a prior systematic review of emergency care interventions feasible within the context of HMA activities and low-resource health care systems were used to model mortality reduction among EO victims. Interventions were categorized using the World Health Organization (WHO) Emergency Care System Framework sites of “scene,” “transport,” and “facility.” The cumulative impact of the interventions on EO-related mortality was estimated using pooled effect estimates and simulation modeling.

The meta-analysis included 16 reports from 13 countries, representing 127,505 injured persons. Pooled effect estimates across subcategories of emergency care interventions were 0.42 for layperson transportation (95%CI, 0.24-0.74), 0.79 for prehospital notification systems (95%CI, 0.51-1.19), 0.52 for prehospital trauma care training courses (95%CI, 0.46-0.59), 0.67 for facility-based trauma care training courses (95%CI, 0.48-0.92), and 0.66 for facility-based trauma team organization and activation protocols (95%CI, 0.45-0.97). A 68% reduction in mortality (95%UI, 57%-79%) was observed when implementing the full set of interventions in a region with no prior implemented interventions.

Enhanced coordination between HMA and health actors to implement a structured set of emergency care interventions holds potential to significantly reduce preventable death among civilian EO casualties.

When unexploded ordnance (UXO) is embedded in the body, the effect of explosive weapons used in conflict is amplified. Though relatively rare, such events present potentially devastating consequences for the patient and medical providers as routine diagnostic and therapeutic procedures hold potential to initiate detonation of the embedded UXO (eUXO). The objective is to identify and synthesize available literature relating to the management of eUXO in low resource settings.

A scoping review was conducted using PRISMA-ScR methodology to evaluate literature in all languages from all date ranges until January 31, 2024, discussing the management of casualties with eUXO, including types of ordnance, injury patterns, diagnostics, resource utilization, surgical interventions, and outcomes.

Search strings identified 3,425 records. After title and abstract screening 3,397 were excluded yielding 18 for full text screening of which 5 were excluded. Therefore 13 reports were included in analysis. Data variable reporting was heterogeneous but themes and subthemes regarding safety, planning and communication emerged.

A scoping review was conducted to identify gaps in existing literature on the management of eUXO in low resource settings. Coordinated engagement from personnel representing a variety of clinical and non-clinical specialties is required to safely manage eUXO.

Simulation materials for layperson first responder (LFR) trainings used in high-resource settings are prohibitively expensive for use in low- and low-middle income countries. To date, no structured approach to community-engaged design in identifying accessible and acceptable simulation materials for LFR trainings has been developed.

We conducted 2 workshops with male (18) and female participants (10) in a rural village in the Centre-Est region of Burkina Faso using principles of community-engaged research to define solutions for improvised LFR training materials.

Participants reported a range of reactions to the use of live trainees and animal models for LFR training including considerations around gender sensitivity, use of animals for training purposes in regions of food insecurity, and religious and cultural barriers to consumption of meat after use for training purposes. A range of locally available options for training materials was identified by participants.

Significant sociocultural variability exists across low-resource environments with implications for the acceptability and availability of improvised materials for LFR training. Affected communities should be engaged in the selection and design of improvisation strategies to ensure context-appropriate adaptation.

Explosive ordnance (EO) and explosive weapons (EW) inflict significant suffering on civilian populations in conflict and post-conflict settings. At present, there is limited coordination between humanitarian mine action (HMA) and emergency care for civilian victims of EO/EW. Key informant interviews with sector experts were conducted to evaluate strategies for enhanced engagement between HMA and emergency care capacity-building in EO/EW-affected settings.

A cross-sectional qualitative study was conducted to interview HMA and health sector experts. Data were analyzed in Dedoose using deductive and inductive coding methods.

Nineteen key informants were interviewed representing sector experts in HMA, health, and policy domains intersecting with the care of EO/EW casualties. Recommendations included integration of layperson first responder trainings with EO risk education, development of prehospital casualty notification systems with standardized health facility capacity mapping, and refresher trainings for HMA medics at local health facilities.

Medical capabilities within the HMA sector hold potential to strengthen emergency care for civilian EO/EW casualties yet in the absence of structured coordination strategies is underutilized for this purpose. Increased HMA engagement in emergency care may enhance implementation of evidence-based emergency care interventions to decrease preventable death and disability among civilian victims of EO/EW in low-resource settings.

Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties.

A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001.

A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC).

This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.

Developmental disorders (DDs) in children are a priority condition and guidelines have been developed for their management within low-resource community settings. However, a key obstacle is lack of open access, reliable and valid tools that lay health workers can use to evaluate the impact of such programmes on child outcomes. We adapted and validated the World Health Organization's Disability Assessment Schedule for children (WHODAS-Child), a lay health worker-administered functioning-related tool, for children with DDs in Pakistan.

Lay health workers administered a version of the WHODAS-Child to parents of children with DDs (N = 400) and without DDs (N = 400), aged 2–12 years, after it was adapted using qualitative study. Factor analysis, validity, reliability and sensitivity to change analyses were conducted to evaluate the psychometric properties of the adapted outcome measure.

Among 800 children, 58% of children were male [mean (s.d.) age 6.68 (s.d. = 2.89)]. Confirmatory Factor Analysis showed a robust factor structure [χ2/df 2.86, RMSEA 0.068 (90% CI 0.064–0.073); Tucker–Lewis Index (TLI) 0.92; Comparative Fit Index (CFI) 0.93; Incremental Fit Index (IFI) 0.93]. The tool demonstrated high internal consistency (α 0.82–0.94), test–retest [Intra-class Correlation Coefficient (ICC) 0.71–0.98] and inter-data collector (ICC 0.97–0.99) reliabilities; good criterion (r −0.71), convergent (r −0.35 to 0.71) and discriminative [M (s.d.) 52.00 (s.d. = 21.97) v. 2.14 (s.d. = 4.00); 95% CI −52.05 to −47.67] validities; and adequate sensitivity to change over time (ES 0.19–0.23).

The lay health worker administrated version of adapted WHODAS-Child is a reliable, valid and sensitive-to-change measure of functional disability in children aged 2–12 years with DDs in rural community settings of Pakistan.