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Halestrap P, Aliba D, Otieno G, Brotherton BJ, Gitura HW, Matson JE, Lee BW, Mbugua E. Development and delivery of a higher diploma in emergency medicine and critical care for clinical officers in Kenya. Afr J Emerg Med 2023; 13:225-229. [PMID: 37701728 PMCID: PMC10494305 DOI: 10.1016/j.afjem.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
The provision of emergency medicine and critical care in a cost-efficient manner has the potential to address many preventable deaths in low- and middle-income countries. Here, utilising Kern's framework for curriculum development, we describe the origins, development and implementation of the Emergency Medicine and Critical Care Clinical Officer training program; Kenya's first training programme for clinical officers in emergency medicine and critical care. Graduates are scattered across the country in diverse settings, ranging from national referral hospitals in the capital, Nairobi, to rural hospitals in northern Kenya. In these locations, they provide clinical care, leadership, and teaching. Similar programmes could be replicated in other locations to help plug the gap in critical care provision in Sub-Saharan Africa.
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Affiliation(s)
| | | | | | | | | | | | - Burton W. Lee
- Critical Care Medicine Department, National Institute of Health, USA
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Lee JA, Armes L, Wachira BW. Using social media in Kenya to quantify road safety: an analysis of novel data. Int J Emerg Med 2022; 15:30. [PMID: 35764949 PMCID: PMC9238258 DOI: 10.1186/s12245-022-00432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries are a large and growing cause of morbidity and mortality in low- and middle-income countries, especially in Africa. Systematic data collection for traffic incidents in Kenya is lacking and in many low- and middle-income countries available data sources are disparate or missing altogether. Many Kenyans use social media platforms, including Twitter; many road traffic incidents are publicly reported on the microblog platform. This study is a prospective cohort analysis of all tweets related to road traffic incidents in Kenya over a 24-month period (February 2019 to January 2021). RESULTS A substantial number of unique road incidents (3882) from across Kenya were recorded during the 24-month study period. The details available for each incident are widely variable, as reported and posted on Twitter. Particular times of day and days of the week had a higher incidence of reported road traffic incidents. A total of 2043 injuries and 1503 fatalities were recorded. CONCLUSIONS Twitter and other digital social media platforms can provide a novel source for road traffic incident and injury data in a low- and middle-income country. The data collected allows for the potential identification of local and national trends and provides opportunities to advocate for improved roadways and health systems for the emergent care from road traffic incidents and associated traumatic injuries.
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Affiliation(s)
- J Austin Lee
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA.
| | - Lyndsey Armes
- School of Public Health, Brown University, Providence, RI, USA
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Saleeby J, Myers JG, Ekernas K, Hunold K, Wangara A, Maingi A, Wilson P, Mutiso V, Zamamiri S, Bacon D, Davis W, Suder J, Agrawal Y, Ogar O, Martin IB, Dunlop S. Retrospective review of the patient cases at a major trauma center in Nairobi, Kenya and implications for emergency care development. Afr J Emerg Med 2019; 9:127-133. [PMID: 31528530 PMCID: PMC6742594 DOI: 10.1016/j.afjem.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/02/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Low- and middle-income countries (LMICs) are continuing to experience a "triple burden" of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya's largest public tertiary care hospital. METHODS This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation. RESULTS A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission. CONCLUSIONS Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world.
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Affiliation(s)
- Julie Saleeby
- University of North Carolina at Chapel Hill, Department of Emergency Medicine, 101 Manning Dr, Chapel Hill, NC 27514, USA
| | - Justin G. Myers
- University of North Carolina at Chapel Hill, Department of Emergency Medicine, 101 Manning Dr, Chapel Hill, NC 27514, USA
| | - Karen Ekernas
- St Joseph Hospital, Department of Emergency Department, 1375 19th Ave, Denver, CO 80218, USA
| | - Katherine Hunold
- The Ohio State University, Department of Emergency Medicine, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Ali Wangara
- Kenyatta National Hospital, Accident and Emergency Department, Hospital Road, Upper Hill, Nairobi 00202, Kenya
| | - Alice Maingi
- Kenyatta National Hospital, Accident and Emergency Department, Hospital Road, Upper Hill, Nairobi 00202, Kenya
| | - Peyton Wilson
- University of North Carolina at Chapel Hill, Department of Pediatrics, 130 Mason Farm Rd, Chapel Hill, NC 27514, USA
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Department of Orthopedics, University Way, Nairobi, Kenya
| | - Sarah Zamamiri
- Nova Southeastern University, College of Osteopathic Medicine, 3200 S University Dr, Davie, FL 33328, USA
| | - Daniel Bacon
- University of North Carolina, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA
| | - Wes Davis
- Edward Via College of Osteopathic Medicine - Carolinas Campus, 350 Howard St, Spartanburg, SC 29303, USA
| | - John Suder
- University of North Carolina, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA
| | - Yash Agrawal
- University of North Carolina, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA
| | - Ogar Ogar
- University of North Carolina, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA
| | - Ian B.K. Martin
- West Virginia University, Department of Emergency Medicine, 1 Medical Center Dr, Morgantown, WV 26506, USA
| | - Stephen Dunlop
- Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave, Minneapolis, MN 55415, USA
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Riebensahm C, Ka D, Sow A, Semmo N, Wandeler G. A closer look at the spectrum of drug-induced liver injury in sub-Saharan Africa. Expert Rev Clin Pharmacol 2019; 12:875-883. [PMID: 31269818 DOI: 10.1080/17512433.2019.1638251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Drug-induced liver injury (DILI) has become the most frequent cause of acute liver failure in high-income countries. However, little is known about the determinants of DILI in sub-Saharan Africa (SSA), where the prescription of antimicrobials and the use of potentially hepatotoxic traditional medicine are common. Areas covered: Based on an extensive literature search, we summarize current data available on the epidemiology and risk factors of DILI in SSA. We discuss the most likely causes of DILI in the region, including antimicrobial therapies and traditional medicine. We also highlight research gaps as well as barriers to diagnosis and management of the condition, and explore ways to address these important challenges. Expert opinion: DILI is underestimated in SSA and several factors challenge its early diagnosis, including lack of information on the causes of DILI in the region, sub-optimal knowledge about the condition among clinicians, and structural difficulties faced by health care systems. In order to better prevent the occurrence of DILI and its complications, it is crucial to enhance awareness among health care providers and patients, adapt drug prescription habits and regulations, and improve current knowledge on the main risk factors for DILI, including host genetic and environmental determinants.
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Affiliation(s)
- Carlotta Riebensahm
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Daye Ka
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal
| | - Abdoul Sow
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Division of Gastroenterology and Hepatology, Hôpital Principal , Dakar , Senegal
| | - Nasser Semmo
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal.,Department of Infectious Diseases, Bern University Hospital, University of Bern , Bern , Switzerland
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Blankson PK, Amoako JKA, Asah-Opoku K, Odei-Ansong F, Lartey MY. Epidemiology of injuries presenting to the accident centre of Korle-Bu Teaching Hospital, Ghana. BMC Emerg Med 2019; 19:39. [PMID: 31325955 PMCID: PMC6642582 DOI: 10.1186/s12873-019-0252-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Injuries directly lead to 5 million deaths every year, accounting for 9% of all deaths worldwide. While knowledge of the pattern of injuries is essential to plan health interventions to reduce the incidence of injuries, these are not thoroughly described in Ghana. The aim of this study was to describe the epidemiology of injuries seen at the Accident centre of the Korle-Bu Teaching Hospital, Ghana’s main referral hospital. Method A retrospective review of two-year records of all patients who attended the Accident centre of the Korle-Bu Teaching Hospital from January 2016 to December 2017 was done. Data on the cause of injuries was the main focus of this review. Results A total of 17,860 patients’ records were included in the study. There were 12,116 (67.8%) males and 5,744 (32.2%) females. The ages of the patients seen during the period ranged from three (3) days to 101 years. The overall mean age was 27.9 (±18.2). Majority of the injuries resulted from road traffic accidents and falls, accounting for 39.1 and 19.7% respectively. Conclusion Road Traffic accidents (RTA), especially motorcycle related, are a significant cause of injuries in Ghana. Future studies should focus on interventions that can reduce the incidence of RTA’s to reduce the number of injuries that present to the Korle-Bu Teaching Hospital.
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Affiliation(s)
- Paa-Kwesi Blankson
- Department of Oral & Maxillofacial Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Joachim K A Amoako
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana. .,School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box KB-20, Accra, Ghana.
| | - Kwaku Asah-Opoku
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box KB-20, Accra, Ghana
| | | | - Margaret Y Lartey
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box KB-20, Accra, Ghana.,Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
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Brotherton BJ, Halestrap P, Mbugua E, Gitura H, Aliba D, Matson JE, Lee BW. ECCCOing the call for emergency and critical care training in low middle-income countries. Crit Care 2019; 23:244. [PMID: 31277698 PMCID: PMC6612168 DOI: 10.1186/s13054-019-2532-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/28/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | - David Aliba
- Kijabe Hospital, PO Box 20, Kijabe, 00220, Kenya
| | | | - Burton W Lee
- Division of Pulmonary, Allergy & Critical Care Medicine, University of PIttsburgh School of Medicine, Pittsburgh, PA, USA
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Gebru AA, Mosadeghrad AM, Sari AA. Perceptions of leadership, motivation, structure, and assurance for implementation of emergency medical services in Ethiopia: Perspectives of emergency medical services case teams based on focus group discussions. Hum Antibodies 2019; 27:53-71. [PMID: 31127761 DOI: 10.3233/hab-190383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The research was assessed the Ethiopian Emergency Medical Services Case teams' and officers views on Emergency Medical services in Ethiopia. The aim of study was to present the point of views, prospect and priorities of Emergency medical services case teams and its coordinator along some main dimensions of emergency medical services, such as Leadership, Motivation, Structure, and Assurance for implementation. METHODS Six focus group discussion were facilitated with EMS case teams, focal persons and FMoH emergency medical services case teams from December to August, 2017 in all regions chosen of the study. The focus group techniques were used in the study as qualitative research method for examination of viewpoints of case team members towards to the emergency medical care system and overall pre-hospital and at hospital emergency care services. The discussion was addressing the topics of: general aspects of emergency Medical Services (EMS) and which occupations included in EMS; possibilities to importance review EMS issues based on Leadership, Motivation, Structure, and Assurance for implementation of EMS in the country. Finally, thematic analysis was used to evaluate data sets which collected during the focus group discussion. RESULTS There were 6 focus groups in total: an Emergency medical services case teams, officers, Directorates, and integrated disease prevention and control program coordinators groups in each of the regional, city Administration Health Bureau and Federal Ministry of Health in Ethiopia. Findings of the thematic analysis were summarized along the following dimensions: Leadership, Motivation, Structure, and Assurance for implementation. The result shown that lack of resources, shortage of training, lack of professionals and community awareness on EMS, immaturity of EMS strategic plan and lack of revision, workload as a result of limited skilled manpower, lack of partnerships and collaboration on EMS and lack of research and community services evidence are among factors affecting the quality EMS and continuity of the program at various health care facilities at the regional and national levels. CONCLUSION The study shows views of the Ethiopian Emergency Medical Services Case teams' and officers in Emergency Medical services in Ethiopia. The participants were considered determining factors of the EMS were rather similar among the participated regional, city Administration Health Bureau and Federal Ministry of health. Nonetheless, there was some degree of difference among those participated institutes. Especially, as a national level, Ethiopian Ministry of Health is exists only one emergency medical service directorate that leading the whole national activities. Therefore, EMS program need to respond to the challenges by respondents to articulate emergency medical services policies appropriate to Ethiopia, including the pre-hospital, at hospital care system and Ambulance services with more reformed professional skills and case team work at country level including all regions, Zone, Woreda (Districts) and other related sectors.
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Affiliation(s)
- Addis Adera Gebru
- Department of Health Management and Economics, International Campus, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Zaidi AA, Dixon J, Lupez K, De Vries S, Wallis LA, Ginde A, Mould-Millman NK. The burden of trauma at a district hospital in the Western Cape Province of South Africa. Afr J Emerg Med 2019; 9:S14-S20. [PMID: 31073509 PMCID: PMC6497867 DOI: 10.1016/j.afjem.2019.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/19/2018] [Accepted: 01/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre. METHODS An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis. RESULTS Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18-34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm-7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries. CONCLUSION This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.
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Affiliation(s)
- Ali A. Zaidi
- Indiana University, School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Julia Dixon
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Kathryn Lupez
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States
| | - Shaheem De Vries
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Lee A. Wallis
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Adit Ginde
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Nee-Kofi Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
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Patel H, Suarez S, Shaull L, Edwards J, Altawil Z, Owuor J, Rogo D, Schwartz K, Richard L, Burke TF. Patient Characteristics from an Emergency Care Center in Rural Western Kenya. J Emerg Med 2018; 56:80-86. [PMID: 30527618 DOI: 10.1016/j.jemermed.2018.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emergency care is a neglected area of focus in many low- and middle-income countries. There is a paucity of research on types and frequencies of acute illnesses and injuries in low-resource settings. OBJECTIVE The primary objective of this study was to describe the demographic characteristics and emergency conditions of patients that presented to a new emergency care center (ECC) at Sagam Community Hospital in Luanda, Kenya. METHODS Patient demographic characteristics, modes of arrival, chief symptoms, triage priorities, self-reported human immunodeficiency virus status, tests performed, interventions, discharge diagnoses, and dispositions were collected for all patients that presented to the Sagam Community Hospital ECC. RESULTS Between October 1, 2016 and September 30, 2017, 14,518 patients presented to the ECC. The most common mode of arrival to Sagam Community Hospital was by foot (n = 12,605 [86.8%]). There were 8931 (61.5%) female patients and 5571 (38.4%) male patients. Of the total visits, 12,668 (87.3%) were triaged Priority III (lowest priority), 1239 (8.5%) were Priority II, and 293 (2.0%) were Priority I (highest priority). The most common chief symptoms were headache (n = 3923 [15.2%]), hotness of body or chills (n = 2877 [8.8%]), and cough (n = 1827 [5.5%]). The three most common discharge diagnoses were malaria (n = 3692 [18.9%]), acute upper respiratory infection (n = 1242 [6.3%]), and gastritis/duodenitis (n = 1210 [6.2%]). CONCLUSIONS Although opening an ECC in rural Kenya attracted patients in need of care, access was limited primarily to those that could arrive on foot. ECCs in rural sub-Saharan Africa have the potential to provide quality care and support attainment of Sustainable Development Goals.
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Affiliation(s)
- Hiren Patel
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sebastian Suarez
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lance Shaull
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Jeffrey Edwards
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Zaid Altawil
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Boston Medical Center, Boston, Massachusetts
| | - Joseph Owuor
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Debora Rogo
- African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Kevin Schwartz
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Luate Richard
- African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya
| | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; African Institute for Health Transformation at Sagam Community Hospital, Luanda, Kenya; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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van Hoving DJ, Hunter LD, Gerber R(EJ, Lategan HJ, Marks CJ. The burden of intentional self-poisoning on a district-level public Hospital in Cape Town, South Africa. Afr J Emerg Med 2018; 8:79-83. [PMID: 30456153 PMCID: PMC6223584 DOI: 10.1016/j.afjem.2018.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/14/2018] [Accepted: 03/28/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Intentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town. METHODS Adult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables. RESULTS A total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n = 132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n = 152, 79.2%), were transported from home (n = 124, 64.6%) and arrived by ambulance (n = 126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45 m-7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n = 100, 52.1%) and the Poison Severity Score (minor severity n = 107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n = 48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported. DISCUSSION Intentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further.
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Affiliation(s)
- Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, P.O Box 241, Cape Town 8000 South Africa
| | | | - Rachel (Elre) J. Gerber
- Division of Emergency Medicine, Stellenbosch University, P.O Box 241, Cape Town 8000 South Africa
| | | | - Carine J. Marks
- Tygerberg Poison Information Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Wanjiku G, Janeway H, Foggle J, Partridge R, Wang Y, Kearney A, Levine AC, Carter J, Tabu JS. Assessing the impact of an emergency trauma course for senior medical students in Kenya. Afr J Emerg Med 2017; 7:167-171. [PMID: 30456133 PMCID: PMC6234127 DOI: 10.1016/j.afjem.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/22/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Ninety percent of all injury-related deaths occur in low- and middle-income countries. The WHO recommends short, resource-specific trauma courses for healthcare providers. Studies show that teaching trauma courses to medical students in developed countries leads to significant increases in knowledge and skill. High costs hinder widespread and sustained teaching of these courses in low-income countries. Methods A two-day trauma course was designed for students at Moi College of Health Sciences in Eldoret, Kenya. Participants underwent pre- and post-course written and simulation testing and rated their confidence in 21 clinical scenarios and 15 procedures pre- and post-course using a five point Likert scale. A subset of the students was re-evaluated nine months post-course. Using the paired t-test, mean written, simulation and confidence scores were compared pre-course, immediately post-course and nine months post-course. Results Twenty-two students were enrolled. Written test score means were 61.5% pre-course and 76.9% post-course, mean difference 15.5% (p < 0.001). Simulation test score means were 36.7% pre-course and 82.2% post-course, mean difference 45.5% (p < 0.001). Aggregate confidence scores were 3.21 pre-course and 4.72 post-course (scale 1–5). Ten out of 22 (45.5%) students were re-evaluated nine months post-course. Results showed written test score mean of 75%, simulation score mean of 61.7%, and aggregate confidence score of 4.59 (scale 1–5). Mean differences between immediate post- and nine months post-course were 1.6% (p = 0.75) and 8.7% (p = 0.10) for the written and simulation tests, respectively. Conclusion Senior Kenyan medical students demonstrated statistically significant increases in knowledge, skills and confidence after participating in a novel student trauma course. Nine months post-course, improvements in knowledge skills and confidence were sustained.
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Affiliation(s)
- Grace Wanjiku
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
- Corresponding author. @gw_wanjiku
| | - Hannah Janeway
- Alpert Medical School of Brown University, Providence, RI, United States
| | - John Foggle
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - Robert Partridge
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - Yvonne Wang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - Alexis Kearney
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - Jane Carter
- Department of Internal Medicine, Alpert Medical School of Brown University, Providence, RI, United States
| | - John S. Tabu
- Department of Disaster Risk Management, Moi University College of Health Sciences Eldoret, Kenya
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Marsala JM, Faye F, BeLue R, Schoeck O. Characterising emergency centre encounters in Mbour, Senegal as emergent-emergency care, emergent-primary care or non-emergent. Afr J Emerg Med 2017; 7:124-129. [PMID: 30456123 PMCID: PMC6234195 DOI: 10.1016/j.afjem.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 04/26/2017] [Accepted: 05/17/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Emergency medicine is a relatively new specialty in Africa, with the first emergency medicine training programme only started in South Africa in 2004. Continued emergency centre development and preparedness relies on a better understanding of the quantity and category of emergency centre encounters within the various African regions. METHODS This study was conducted over four, consecutive months in 2014 using a retrospective chart review, aimed to examine the types of visits made to one emergency centre at the Grande Mbour Hospital in Mbour, Senegal. The New York University Emergency Department Algorithm was used to classify emergency centre encounters. Each diagnosis included in this study was classified per the algorithm as non-emergent; emergent but primary care treatable; emergent with emergency centre care needed but avoidable/preventable; and emergent with emergency centre care needed and not avoidable/preventable. The algorithm also categorised diagnoses of injury, mental health problems, alcohol, or substance abuse. RESULTS This study included 1268 diagnoses from the emergency centre. The most common presentations in Mbour, Senegal were injuries, with 302 cases (33%), and from the category: emergent but primary care treatable, with 303 cases (33%). In total, 174 cases (19%) were classified as: non-emergent. While only 93 cases (10%) were considered: emergency care needed/preventable or avoidable, a substantial number (n = 218, 24%) were categorised as: emergent with emergency centre care needed and not avoidable/preventable. CONCLUSION This study provides the first description of patients presenting for care in the emergency centre of Mbour's hospital and demonstrates the wide range of illnesses and types of trauma that the emergency centre must accommodate while contending with the limited resources available in the area. Understanding the burden of disease will help prioritise resources appropriately.
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Affiliation(s)
- Julia M. Marsala
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Rhonda BeLue
- Department of Health Policy and Administration, Pennsylvania State University, State College, PA, USA
| | - Otto Schoeck
- Pennsylvania State University College of Medicine, Hershey, PA, USA
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13
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Kannan VC, Ramalanjaona G, Andriamalala CN, Reynolds TA. The clinical practice of emergency medicine in Mahajanga, Madagascar. Afr J Emerg Med 2016; 6:5-11. [PMID: 30456057 PMCID: PMC6233243 DOI: 10.1016/j.afjem.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/20/2015] [Accepted: 12/02/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Little is documented concerning the clinical practice of emergency care in low- and middle-income countries. The lack of structural models presents serious obstacles to the development of effective emergency care services. This study provides such a model by describing the clinical practice at the emergency centre of the Centre Hôpitalier Universitaire de Mahajanga in Madagascar. Methods This was a retrospective chart review of all adult patients presenting to the emergency centre from September to November 2012. Archived chart data were extracted into a computer database. Data included: age, sex, date, diagnostic investigations, procedures, medications, and diagnosis. Results 727 charts were reviewed, averaging eight patients per day. The three most frequent pathologies observed were trauma, gastrointestinal, and infectious disease. A total of 392 received diagnostic investigations. These were chiefly complete blood counts (n = 218), blood glucose (n = 155) and ECG (n = 92). Chest X-rays (n = 83), extremity X-rays (n = 55) and skull/face X-rays (n = 44) comprised the most common imaging. Ultrasounds were primarily abdominal (n = 9), renal/genitourinary (n = 6), and obstetric (n = 2). Therapeutic interventions were performed in 564 patients, most commonly intravenous access (n = 452) and wound/orthopaedic care (n = 185). Medications were administered to 568 patients, mostly anti-inflammatory/analgesics (n = 463) and antibiotics (n = 287). Conclusion This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.
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Affiliation(s)
- Vijay C. Kannan
- University of Texas Southwestern, Division of Emergency Medicine, Dallas, TX, USA
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA
- Correspondence to Vijay C. Kannan.
| | | | | | - Teri A. Reynolds
- Emergency Medicine Department, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- University of California San Francisco, Emergency Medicine and Global Health Sciences, CA, USA
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14
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Kannan VC, Andriamalala CN, Reynolds TA. The burden of acute disease in Mahajanga, Madagascar - a 21 month study. PLoS One 2015; 10:e0119029. [PMID: 25738300 PMCID: PMC4349786 DOI: 10.1371/journal.pone.0119029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 01/26/2015] [Indexed: 11/24/2022] Open
Abstract
Background Efforts to develop effective and regionally-appropriate emergency care systems in sub-Saharan Africa are hindered by a lack of data on both the burden of disease in the region and on the state of existing care delivery mechanisms. This study describes the burden of acute disease presenting to an emergency unit in Mahajanga, Madagascar. Methods and Findings Handwritten patient registries on all emergency department patients presenting between 1 January 2011 and 30 September 2012 were reviewed and data entered into a database. Data included age, sex, diagnosis, and disposition. We classified diagnoses into Clinical Classifications Software (CCS) multi-level categories. The population was 53.5% male, with a median age of 31 years. The five most common presenting conditions were 1) Superficial injury; contusion, 2) Open wounds of head; neck; and trunk, 3) Open wounds of extremities, 4) Intracranial injury, and 5) Unspecified injury and poisoning. Trauma accounted for 48%, Infectious Disease for 15%, Mental Health 6.1%, Noncommunicable 29%, and Neoplasms 1.2%. The acuity seen was high, with an admission rate of 43%. Trauma was the most common reason for admission, representing 19% of admitted patients. Conclusions This study describes the burden of acute disease at a large referral center in northern Madagascar. The Centre Hôpitalier Universitaire de Mahajanga sees a high volume of acutely ill and injured patients. Similar to other reports from the region, trauma is the most common pathology observed, though infectious disease was responsible for the majority of adult mortality. Typhoid fever other intestinal infections were the most lethal CCS-coded pathologies. By utilizing a widely understood classification system, we are able to highlight contrasts between Mahajanga’s acute and overall disease burden as well as make comparisons between this region and the rest of the globe. We hope this study will serve to guide the development of context-appropriate emergency medicine systems in the region.
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Affiliation(s)
- Vijay C. Kannan
- University of Texas Southwestern, Division of Emergency Medicine, Dallas, Texas, United States of America
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona, United States of America
- * E-mail:
| | | | - Teri A. Reynolds
- Muhimbili National Hospital, Emergency Medicine Department, Dar Es Salaam, Tanzania
- University of California San Francisco, Emergency Medicine and Global Health Sciences, San Francisco, California, United States of America
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Yan LD, Mahadevan SV, Yore M, Pirrotta EA, Woods J, Somontha K, Sovannra Y, Raman M, Cornell E, Grundmann C, Strehlow MC. An observational study of adults seeking emergency care in Cambodia. Bull World Health Organ 2014; 93:84-92. [PMID: 25883401 PMCID: PMC4339966 DOI: 10.2471/blt.14.143917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 11/04/2022] Open
Abstract
Objective To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals. Methods Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation. Findings In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients’ mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired. Conclusion In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.
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Affiliation(s)
- Lily D Yan
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA)
| | - Swaminatha V Mahadevan
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA)
| | - Mackensie Yore
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA)
| | - Elizabeth A Pirrotta
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA)
| | - Joan Woods
- University Research Co. Centre for Human Services, Phnom Penh, Cambodia
| | - Koy Somontha
- University Research Co. Centre for Human Services, Phnom Penh, Cambodia
| | - Yim Sovannra
- Deutsche Gesellschaft für Internationale Zusammenarbeit, Phnom Penh, Cambodia
| | - Maya Raman
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erika Cornell
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Matthew C Strehlow
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA)
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