Reconstructing Trauma System Performance in Nigeria Through Implementation Science: A National Multi-Phase Mixed Methods Study

Nigeria lacks a formal, coordinated national trauma system, contributing to preventable mortality from injuries that account for one of the highest absolute burdens of trauma-related death globally. Despite decades of advocacy, implementation of structured trauma systems has stalled, and the barriers to and facilitators of trauma system development in the Nigerian context have not been rigorously examined through an implementation science lens. This study reconstructs the determinants of trauma system performance in Nigeria through a national multi-phase mixed methods implementation science study. Phase 1 comprises a national trauma mortality audit reviewing 10,000 trauma deaths across 40 emergency departments in all six geopolitical zones, identifying preventable death fractions and clinical system failure modes. Phase 2 applies the Consolidated Framework for Implementation Research to analyse contextual facilitators and barriers through 120 semi-structured interviews with emergency physicians, surgeons, paramedics, health commissioners, and road safety officials. Phase 3 uses Participatory Action Research with a national expert panel to co-design an Implementation Blueprint for Trauma System Development in Nigeria. Quantitative mortality data are analysed using multilevel regression in Stata, and qualitative data are analysed using framework analysis in NVivo. Original contributions include the first implementation science framework for national trauma system development in sub-Saharan Africa, grounded in Nigerian contextual evidence. Findings will be submitted as a policy brief to the Federal Ministry of Health and FRSC. Keywords: trauma system, implementation science, preventable mortality, national policy, Nigeria.