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Alkhawashki HMI. Challenges of orthopaedics and trauma care in the Africa, Near and Middle East region. INTERNATIONAL ORTHOPAEDICS 2023; 47:2897-2899. [PMID: 37985481 DOI: 10.1007/s00264-023-06030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
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Flaherty KE, Klarman MB, Zakariah AN, Mahama MN, Osei-Ampofo M, Nelson EJ, Becker TK. Evaluating the prerequisites for adapting a paediatric nighttime telemedicine and medication delivery service to a setting with high malarial burden: A cross-sectional pre-implementation study. Trop Med Int Health 2023; 28:763-770. [PMID: 37536706 DOI: 10.1111/tmi.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE We sought to evaluate the prerequisites (demand, interest, feasibility) for adapting a paediatric nighttime telemedicine and medication delivery service (TMDS) to Ghana. METHODS A cross-sectional survey of households and associated healthcare providers was conducted in urban and rural Ghana. Households were identified through randomised geospatial sampling; households with at least one child <10 years were enrolled. Household surveys collected information relating to demographics, household resources, standardised case scenarios, recent paediatric health events, satisfaction with healthcare access, and interest in TMDS intervention models. Providers were identified by households and enrolled. Provider surveys collected provider type, hours of operation, services, and opinions of a TMDS model. RESULTS A total of 511 (263 urban, 248 rural) households and 18 providers (10 urban, 8 rural) were surveyed. A total of 262 health events involving children <10 years were reported, of which 47% occurred at night. Care was sought for >70% of health events presenting at night; however, care-seeking was delayed until morning or later for >75% of these events; 54% of households expressed dissatisfaction with their current access to paediatric care at night; 99% of households expressed that a nighttime TMDS service for children would be directly useful to their families. Correspondingly, 17 of 18 providers stated that a TMDS was needed in their community; >99% of households had access to a cellular phone. All households expressed willingness to use their phones to call a TMDS and allow a TMDS provider into their homes at night. Willingness to pay and provider-recommended price points varied by setting. CONCLUSIONS Prerequisites for adapting a TMDS to Ghana were met. A nighttime paediatric TMDS service was found to be needed, appealing, and feasible in Ghana. These data motivate the adaptation of a TMDS to urban and rural Ghana.
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Affiliation(s)
- Katelyn E Flaherty
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Molly B Klarman
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Ahmed N Zakariah
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- National Ambulance Service, Ministry of Health, Accra, Ghana
| | | | | | - Eric J Nelson
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Torben K Becker
- Section of Global Health, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for African Studies, Colleges of Liberal Arts & Sciences, University of Florida, Gainesville, Florida, USA
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Awini AB, Opoku DA, Ayisi-Boateng NK, Osarfo J, Sulemana A, Yankson IK, Osei-Ampofo M, Zackaria AN, Newton S. Prevalence and determinants of occupational injuries among emergency medical technicians in Northern Ghana. PLoS One 2023; 18:e0284943. [PMID: 37098096 PMCID: PMC10129006 DOI: 10.1371/journal.pone.0284943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Emergency Medical Technicians (EMTs) are the primary providers of prehospital emergency medical services. The operations of EMTs increase their risks of being exposed to occupational injuries. However, there is a paucity of data on the prevalence of occupational injuries among EMTs in sub-Saharan Africa. This study, therefore, sought to estimate the prevalence and determinants of occupational injuries among EMTs in the northern part of Ghana. METHODS A cross-sectional study was conducted among 154 randomly recruited EMTs in the northern part of Ghana. A pre-tested structured questionnaire was used to collect data on participants' demographic characteristics, facility-related factors, personal protective equipment use, and occupational injuries. Binary and multivariate logistic regression analyses with a backward stepwise approach were used to examine the determinants of occupational injuries among EMTs. RESULTS In the 12 months preceding data collection, the prevalence of occupational injuries among EMTs was 38.6%. Bruises (51.8%), and sprains/strains (14.3%) were the major types of injuries reported among the EMTs. The key determinants of occupational injury among EMTs were male sex (AOR: 3.39, 95%CI: 1.41-8.17), an absence of a health and safety committee at the workplace (AOR: 3.92, 95%CI: 1.63-9.43), absence of health and safety policy at the workplace (AOR: 2.76, 95%CI: 1.26-6.04) and dissatisfaction with health and safety measures at the workplace (AOR: 2.51, 95%CI: 1.10-5.71). CONCLUSION In the twelve months before to the data collection for this study, the prevalence of occupational injuries among EMTs of the Ghana National Ambulance Service was high. The creation of health and safety committees, the creation of health and safety rules, and the strengthening of current health and safety procedures for EMTs are all possible ways to lessen this.
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Affiliation(s)
- Ali Baba Awini
- Ghana National Ambulance Service, Upper East Region, Ghana
| | - Douglas Aninng Opoku
- Department of Occupational and Environmental Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Allen Clinic, Family Healthcare Services, Kumasi, Ghana
| | - Nana Kwame Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Health Science, Ho, Ghana
| | - Alhassan Sulemana
- Department of Environmental Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Yankson
- Council for Scientific and Industrial Research-Building and Road Research Institute, Kumasi, Ghana
| | - Maxwell Osei-Ampofo
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sam Newton
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Peterson WJ, Munzer BW, Tucker RV, Losman ED, Harvey C, Hatton C, Sefa N, Bassin BS, Hsu CH. Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1414-1418. [PMID: 33856362 PMCID: PMC8475643 DOI: 10.1097/acm.0000000000004120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The most effective way to train clinicians to safely don and doff personal protective equipment (PPE) and perform aerosol-generating procedures (AGPs), such as intubations, is unknown when clinician educators are unavailable, as they have been during the COVID-19 pandemic. Proper PPE and airway management techniques are critical to prevent the transmission of respiratory illnesses such as COVID-19. APPROACH In March 2020, the authors implemented a structured train-the-trainers curriculum to teach PPE techniques and a modified airway management algorithm for suspected COVID-19 patients. A single emergency medicine physician trainer taught 17 subsequent emergency medicine and critical care physician trainers the proper PPE and airway management techniques. The initial trainer and 7 of the subsequent trainers then instructed 99 other emergency medicine resident and attending physicians using in situ simulation. Trainers and learners completed retrospective pre-post surveys to assess their comfort teaching the material and performing the techniques, respectively. OUTCOMES The surveys demonstrated a significant increase in the trainers' comfort in teaching simulation-based education, from 4.00 to 4.53 on a 5-point Likert scale (P < .005), and in teaching the airway management techniques through simulation, from 2.47 to 4.47 (P < .001). There was no difference in the change in comfort level between those learners who were taught by the initial trainer and those who were taught by the subsequent trainers. These results suggest that the subsequent trainers were as effective in teaching the simulation material as the initial trainer. NEXT STEPS Work is ongoing to investigate clinician- and patient-specific outcomes, including PPE adherence, appropriate AGP performance, complication rate, and learners' skill retention. Future work will focus on implementing similar train-the-trainers strategies for other health professions, specialties, and high-risk or rare procedures.
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Affiliation(s)
- William J. Peterson
- W.J. Peterson is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-3950-3054
| | - Brendan W. Munzer
- B.W. Munzer is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ryan V. Tucker
- R.V. Tucker is clinical lecturer, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eve D. Losman
- E.D. Losman is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carrie Harvey
- C. Harvey is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Colman Hatton
- C. Hatton is a resident, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nana Sefa
- N. Sefa is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8693-8080
| | - Ben S. Bassin
- B.S. Bassin is assistant professor, Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, Michigan
| | - Cindy H. Hsu
- C.H. Hsu is assistant professor, Departments of Emergency Medicine and Surgery and Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8192-6969
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Lindquist B, Gaiha SM, Vasudevan A, Dooher S, Leggio W, Mulkerin W, Zozula A, Strehlow M, Sebok‐Syer SS, Mahadevan SV. Development and implementation of a novel Web-based gaming application to enhance emergency medical technician knowledge in low- and middle-income countries. AEM EDUCATION AND TRAINING 2021; 5:e10602. [PMID: 34124530 PMCID: PMC8171777 DOI: 10.1002/aet2.10602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Increasing access to high-quality emergency and prehospital care is an important priority in low- and middle-income countries (LMICs). However, ensuring that emergency medical technicians (EMTs) maintain their clinical knowledge and proficiency with procedural skills is challenging, as continuing education requirements are still being introduced, and clinical instructional efforts need strengthening. We describe the development and implementation of an innovative asynchronous learning tool for EMTs in the form of a Web-based trivia game. METHODS Over 500 case-based multiple-choice questions (covering 10 essential prehospital content areas) were created by experts in prehospital education, piloted with EMT educators from LMICs, and delivered to EMTs through a Web-based quiz game platform over a 12-week period. We enrolled 252 participants from nine countries. RESULTS Thirty-two participants (12.7%) completed the entire 12-week game. Participants who completed the game were administered a survey with a 100% response rate. Ninety-three percent of participants used their mobile phone to access the game. Overall, participants reported that the interface was easy to use (93.8% agreed or strongly agreed), the game improved their knowledge (100% agreed or strongly agreed), and they felt better prepared for their jobs (100% agreed or strongly agreed). The primary motivators for participation were improving patient care (37.5%) and being recognized on the game's leaderboard (31.3%). All participants reported that they would engage in the game again (43.8% agreed and 56.3% strongly agreed) and would recommend the game to their colleagues (34.4% agreed and 65.6% strongly agreed). CONCLUSIONS In conclusion, a quiz game targeting EMT learners from LMICs was viewed as accessible and effective by participants. Future efforts should focus on increasing retention and trialing languages in addition to English.
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Affiliation(s)
- Benjamin Lindquist
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Shivani M. Gaiha
- Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | | | - Sean Dooher
- University of CaliforniaBerkeleyCaliforniaUSA
| | - William Leggio
- Department of EMS EducationCreighton UniversityOmahaNebraskaUSA
| | - William Mulkerin
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Alexander Zozula
- Department of Emergency MedicineUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Matthew Strehlow
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
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Stewart BT, Gyedu A, Goodman SK, Boakye G, Scott JW, Donkor P, Mock C. Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children. Afr J Emerg Med 2021; 11:144-151. [PMID: 33680736 PMCID: PMC7910164 DOI: 10.1016/j.afjem.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Ghana implemented a National Health Insurance Scheme (NHIS) in 2003 as a step toward universal health coverage. We aimed to determine the effect of the NHIS on timeliness of care, mortality, and catastrophic health expenditure (CHE) among children with serious injuries at a trauma center in Ghana. Methods We performed a retrospective cohort study of injured children aged <18 years who required surgery (i.e., proxy for serious injury) at Komfo Anokye Teaching Hospital from 2015 to 2016. Household income data was obtained from the Ghana Statistical Service. CHE was defined as out-of-pocket payments to annual household income ≥10%. Differences in insured and uninsured children were described. Multivariable regression was used to assess the effect of NHIS on time to surgery, length of stay, in-hospital mortality, out-of-pocket expenditure and CHE. Results Of the 263 children who met inclusion criteria, 70% were insured. Mechanism of injury, triage scores and Kampala Trauma Score II were similar in both groups (all p > 0.10). Uninsured children were more likely to have a delay in care for financial reasons (17.3 vs 6.4%, p < 0.001) than insured children, and the families of uninsured children paid a median of 1.7 times more out-of-pocket costs than families with insured children (p < 0.001). Eighty-six percent of families of uninsured children experienced CHE compared to 54% of families of insured children (p < 0.001); however, 64% of all families experienced CHE. Insurance was protective against CHE (aOR 0.21, 95%CI 0.08–0.55). Conclusions NHIS did not improve timeliness of care, length of stay or mortality. Although NHIS did provide some financial risk protection for families, it did not eliminate out-of-pocket payments. The families of most seriously injured children experienced CHE, regardless of insurance status. NHIS and similar financial risk pooling schemes could be strengthened to better provide financial risk protection and promote quality of care for injured children. Despite strides toward universal health coverage with the National Health Insurance Scheme (NHIS) in Ghana, one third of injured children did not have insurance. Families on uninsured injured children pay markedly more out-of-pocket costs than families of insured children. Although families of uninsured children were more likely to experience catastrophic health expenditure (CHE), CHE was commonly experienced regardless of insurance. These findings have useful implications for NHIS, agencies working toward universal health coverage, and trauma systems generally.
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Cox M, Masunge J, Geduld H. A successful hybrid emergency medicine postgraduate partnership in Southern Africa. Afr J Emerg Med 2020; 10:S56-S59. [PMID: 33318903 PMCID: PMC7723910 DOI: 10.1016/j.afjem.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022] Open
Abstract
Emergency Medicine (EM) development is established worldwide and fast developing in Sub-Saharan Africa. Medical specialty development requires multiple human resources and logistics which are frequently not available in LMICs. This article describes an innovative hybrid EM specialization program in Botswana that involved partnership with a neighbouring country in Sub-Saharan Africa. Many initial problems challenged its development, but significant local and regional support led to success. Botswana graduated its first three EM specialists in 2018 and now has an ongoing and sustainable EM program. This regional partnership resulted in numerous academic, research and clinical EM developments for Botswana and SA. UB-UCT EM training Partnership Model is a novel and sustainable cross- African collaboration with significant benefits for both health systems as well as for the individual trainees. This hybrid arrangement should be considered by other LMICs looking for EM specialty training and development.
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Affiliation(s)
- Megan Cox
- University of Sydney, Faculty of Medicine and Health, Australia
- University of Botswana, Faculty of Medicine, Botswana
- Corresponding authors.
| | | | - Heike Geduld
- University of Cape Town, Division of Emergency Medicine, South Africa
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Lindquist BD, Koval KW, Acker PC, Bills CB, Khan A, Zachariah S, Newberry JA, Rao GVR, Mahadevan SV, Strehlow MC. Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept. Open Access Emerg Med 2020; 12:201-210. [PMID: 32982494 PMCID: PMC7505709 DOI: 10.2147/oaem.s249447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India. METHODS From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide). LESSONS LEARNED During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials. CONCLUSION These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.
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Affiliation(s)
- Benjamin D Lindquist
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Kathryn W Koval
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC29425, USA
| | - Peter C Acker
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Corey B Bills
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
- University of California San Francisco, San Francisco, CA94143, USA
| | - Ayesha Khan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Sybil Zachariah
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - G V Ramana Rao
- GVK Emergency Management and Research Institute, Secunderabad, Telangana500078, India
| | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
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Glomb NW, Shah MI, Kosoko AA, Doughty CB, Galapi C, Laba B, Rus MC. Educational impact of a pilot paediatric simulation-based training course in Botswana. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:279-283. [DOI: 10.1136/bmjstel-2019-000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/04/2022]
Abstract
BackgroundAs emergency medical services (EMS) systems develop globally in resource-limited settings, equipping providers with paediatric training is essential. Low-fidelity simulation-based training is an effective modality for training healthcare workers, though limited data exist on the impact of such training programmes. The objective of this study was to evaluate the paediatric portion of a simulation-based curriculum for prehospital providers in Botswana.MethodsThis was a prospective cohort study of EMS providers from more populated regions of Botswana, who attended a 2-day training that included didactic lectures, hands-on skills stations and low-fidelity simulation training. We collected data on participant self-efficacy with paediatric knowledge and skills and performance on both written and simulation-based tests. Self-efficacy and test data were analysed, and qualitative course feedback was summarised.ResultsThirty-one EMS providers participated in the training. Median self-efficacy levels increased for 13/15 (87%) variables queried. The most notable improvements were observed in airway management, newborn resuscitation and weight estimation. Mean written test scores increased by 10.6%, while mean simulation test scores increased by 21.5% (p<0.0001). One hundred per cent of the participants rated the course as extremely useful or very useful.Discussion/ConclusionWe have demonstrated that a low-fidelity simulation-based training course based on a rigorous needs assessment may enhance short-term paediatric knowledge and skills for providers in a developing EMS system in a limited-resource setting. Future studies should focus on studying larger groups of learners in similar settings, especially with respect to the impact of educational programmes like these on real-world patient outcomes.
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Flaherty KE, Zakariah AN, Vescio VA, Osei-Ampofo M, Mahama MN, Agongo V, Becker TK. The state of emergency medical technician education in Ghana. Afr J Emerg Med 2020; 10:107-110. [PMID: 32923318 PMCID: PMC7474231 DOI: 10.1016/j.afjem.2020.01.009] [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: 10/15/2019] [Revised: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objective The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. Methods A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. Results Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). Conclusion The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.
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Affiliation(s)
| | | | - Vicki A. Vescio
- School of Teaching and Learning, University of Florida, Gainesville, FL, USA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Vitus Agongo
- National Ambulance Service, Ministry of Health, Accra, Ghana
| | - Torben K. Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Corresponding author.
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Christmals CD, Armstrong SJ. The essence, opportunities and threats to Advanced Practice Nursing in Sub-Saharan Africa: A scoping review. Heliyon 2019; 5:e02531. [PMID: 31667384 PMCID: PMC6812225 DOI: 10.1016/j.heliyon.2019.e02531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/07/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The conditions that stimulated the implementation of Advanced Practice Nursing programmes all over the world have long been ignored in sub-Saharan Africa. OBJECTIVE This study sought to explore the essence, opportunities and threats to the implementation of an Advanced Practice Nursing (Child Health Nurse Practitioner) programmes in sub-Saharan Africa. METHODS A scoping review was conducted and findings reviewed by a multinational multidisciplinary health experts' team through a Delphi study. RESULTS Children are the majority of the 70-90% of the sub-Saharan African population who reside in the rural areas where access to timely, quality and cost-effective healthcare is poor. The Child Health Nurse Practitioner programme offers an opportunity to provide quality, timely and cost-effective healthcare to sub-Saharan Africa children. Limited resources, opposition from the medical profession, poor nursing governance and lack of context-specific Advanced Practice Nursing benchmark programmes constitute threats to the programme. CONCLUSION The sub-Saharan Africa context provides opportunities that the nursing profession can harness to surmount such threats. Nursing governance structures, however, need to advocate for government and other stakeholders' support for the Child Health Nursing Practitioner programme.
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Affiliation(s)
- Christmal Dela Christmals
- Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, South Africa
- SARChI Chair: Research on the Health Workforce for Equity and Quality, Centre for Health Policy, School of Public Health, University of Witwatersrand, South Africa
| | - Susan Jennifer Armstrong
- Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, South Africa
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Talib Z. Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned. J Grad Med Educ 2019; 11:34-46. [PMID: 31428258 PMCID: PMC6697307 DOI: 10.4300/jgme-d-19-00170] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. OBJECTIVES The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. METHODS We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. RESULTS We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. CONCLUSIONS PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.
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John K, Faye F, Belue R. A descriptive study of trauma cases encountered in the Grand M'Bour Hospital Emergency Department in Senegal. Pan Afr Med J 2019; 32:9. [PMID: 31069002 PMCID: PMC6492306 DOI: 10.11604/pamj.2019.32.9.14550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/28/2018] [Indexed: 01/31/2023] Open
Abstract
Introduction This study analyzed the trends of trauma cases that presented to the Emergency Department (ED) in the Grand M'Bour Hospital. We examined demographics of patients, mechanisms of trauma and types of injuries that result and times from injury to arrival. Methods This was a descriptive study using prospective ED trauma cases. Patients were selected for the study if their chief complaint was related to a traumatic injury. A trauma flow sheet was developed to obtain information. Data was collected from 6/22/16-7/13/16, with 105 cases recorded. Abstracted data included date, time of arrival, time of injury, age, gender, mechanism of injury, injury sustained and disposition. Results Patients presented to the ED for 13 different trauma-related reasons. 71% of the patients encountered had a mechanism of injury related to falls or motor vehicle accidents. The majority of patients who suffered from a fall-or motor vehicle-related injury were children, with ages 0-10 representing 31% and ages 11-20 representing 14% of the total patients. While 29% of patients were seen within 1 hour of the time of their injury, 10% of the patients were not seen until days after their injury. Conclusion We report that traumatic injuries are most commonly a result of fall-related and vehicle-related accidents. Children under the age of 20 years old are a vulnerable population for traumatic injuries. We observed that many patients were unable to seek care within a day of their injury. This was concerning that proper emergency transportation was not available, leading to potential complications or improper healing of injuries. Knowing these trends, an ED can be better prepared to treat these patients.
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Affiliation(s)
- Kenneth John
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Rhonda Belue
- Department of Health Management and Policy, St Louis University, St Louis, MO, USA
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Mould-Millman NK, Dixon J, Burkholder TW, Sefa N, Patel H, Yaffee AQ, Osisanya A, Oyewumi T, Botchey I, Osei-Ampofo M, Sawe H, Lemery J, Cushing T, Wallis LA. Fifteen years of emergency medicine literature in Africa: A scoping review. Afr J Emerg Med 2019; 9:45-52. [PMID: 30873352 PMCID: PMC6400014 DOI: 10.1016/j.afjem.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Emergency medicine (EM) throughout Africa exists in various stages of development. The number and types of scientific EM literature can serve as a proxy indicator of EM regional development and activity. The goal of this scoping review is a preliminary assessment of potential size and scope of available African EM literature published over 15 years. METHODS We searched five indexed international databases as well as non-indexed grey literature from 1999-2014 using key search terms including "Africa", "emergency medicine", "emergency medical services", and "disaster." Two trained physician reviewers independently assessed whether each article met one or more of five inclusion criteria, and discordant results were adjudicated by a senior reviewer. Articles were categorised by subject and country of origin. Publication number per country was normalised by 1,000,000 population. RESULTS Of 6091 identified articles, 633 (10.4%) were included. African publications increased 10-fold from 1999 to 2013 (9 to 94 articles, respectively). Western Africa had the highest number (212, 33.5%) per region. South Africa had the largest number of articles per country (171, 27.0%) followed by Nigeria, Kenya, and Ghana. 537 (84.8%) articles pertained to facility-based EM, 188 (29.7%) to out-of-hospital emergency medicine, and 109 (17.2%) to disaster medicine. Predominant content areas were epidemiology (374, 59.1%), EM systems (321, 50.7%) and clinical care (262, 41.4%). The most common study design was observational (479, 75.7%), with only 28 (4.4%) interventional studies. All-comers (382, 59.9%) and children (91, 14.1%) were the most commonly studied patient populations. Undifferentiated (313, 49.4%) and traumatic (180, 28.4%) complaints were most common. CONCLUSION Our review revealed a considerable increase in the growth of African EM literature from 1999 to 2014. Overwhelmingly, articles were observational, studied all-comers, and focused on undifferentiated complaints. The articles discovered in this scoping review are reflective of the relatively immature and growing state of African EM.
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Affiliation(s)
- Nee-Kofi Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
- Corresponding author.
| | - Julia Dixon
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Taylor W. Burkholder
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nana Sefa
- Beaumont Health System, Royal Oak, MI, USA
| | - Hiren Patel
- Harvard Medical School/Massachusetts General Hospital, Department of Emergency Medicine, MA, USA
| | - Anna Q. Yaffee
- Emory University, Department of Emergency Medicine, Atlanta, GA, USA
| | | | - Tolulope Oyewumi
- University of Colorado, School of Public Health, Department of Epidemiology, Aurora, CO, USA
| | | | - Maxwell Osei-Ampofo
- Komfo Anokye Teaching Hospital, Emergency Medicine Directorate, Kumasi, Ghana
| | - Hendry Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay Lemery
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Tracy Cushing
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, USA
| | - Lee A. Wallis
- University of Cape Town, Division of Emergency Medicine, Observatory, Cape Town, South Africa
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Katz MG, Price RR, Nunez JM. Local Research Catalyzes National Surgical Planning Comment on "Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa". Int J Health Policy Manag 2018; 7:1058-1060. [PMID: 30624880 PMCID: PMC6326645 DOI: 10.15171/ijhpm.2018.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/04/2018] [Indexed: 01/20/2023] Open
Abstract
In 2015 the Lancet Commission on Global Surgery (LCoGS) argued that surgical care is important to national health systems along with the economic viability of countries. Gajewski and colleagues outlined how the Commission’s blueprint has been implemented in sub-Saharan Africa, including two funded research projects that were integrated into national surgical plans. Here, we outline how the five processes proposed by Gajewski and colleagues are critical to integrate research, policy, and on-the-ground implementation. We also propose that, moving forward, the most pressing adjunct in many low- and middle-income countries (LMICs) may be a better characterization of rural surgical practices through rigorous research along with models that enable lessons to inform national policy.
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Affiliation(s)
- Micah G Katz
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Raymond R Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jade M Nunez
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Natala N, Owusu-Antwi R, Donnir G, Kusi-Mensah K, Burns H, Mohiuddin S, Fluent T, Riba M, Dalack G. Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages, Opportunities, and Challenges. Curr Psychiatry Rep 2018; 20:105. [PMID: 30259208 DOI: 10.1007/s11920-018-0959-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC. RECENT FINDINGS Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership. The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.
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Affiliation(s)
- Nakita Natala
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA.
| | | | | | | | - Heidi Burns
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA
| | - Sarah Mohiuddin
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA
| | - Thomas Fluent
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA
| | - Michelle Riba
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA
| | - Gregory Dalack
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48197, USA
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Yiadom MYAB, McWade CM, Awoonor-Williams K, Appiah-Denkyira E, Moresky RT. Public Health Rationale for Investments in Emergency Medicine in Developing Countries - Ghana as a Case Study. J Emerg Med 2018; 55:537-543. [PMID: 30181077 DOI: 10.1016/j.jemermed.2018.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/05/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes. OBJECTIVES Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development. DISCUSSION Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model. Historically, developing countries prioritize primary care efforts and outpatient clinic-based health care models. Ghana has added emergency medicine infrastructure to its health care system in an effort to address the ongoing shift in disease epidemiology as the population urbanizes, mobilizes, and ages. Ghana's investments include prehospital care, personnel training, health care resource provision, communication improvements, transportation services, and new health facilities. This is in addition to re-educating frontline health care providers and developing infrastructure for specialist training. Change was fueled by public support, partnerships between international organizations and domestic stakeholders, and several individual champions. CONCLUSION Emergency medicine as a horizontal component of low- to middle-income countries' health systems may fuel national health and economic development. Ghana's experience may serve as a model.
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Affiliation(s)
- Maame Yaa A B Yiadom
- Department of the Emergency Medicine, The Emergency Department Operations Study Group (EDOSG); Director of the Emergency Care Health Services Research Data Coordinating Center (HSR-DCC), Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
| | - Conor M McWade
- University of California at Davis, Sacramento, California
| | | | | | - Rachel T Moresky
- sidHARTe Program - Strengthen Emergency Systems Program, International Emergency Medicine Fellowship, Population and Family Health & Emergency Medicine Departments, Columbia University Mailman School of Public Health & College of Physicians and Surgeons, New York, New York
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Bitter CC, Rice B, Periyanayagam U, Dreifuss B, Hammerstedt H, Nelson SW, Bisanzo M, Maling S, Chamberlain S. What resources are used in emergency departments in rural sub-Saharan Africa? A retrospective analysis of patient care in a district-level hospital in Uganda. BMJ Open 2018; 8:e019024. [PMID: 29478017 PMCID: PMC5855402 DOI: 10.1136/bmjopen-2017-019024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To determine the most commonly used resources (provider procedural skills, medications, laboratory studies and imaging) needed to care for patients. SETTING A single emergency department (ED) of a district-level hospital in rural Uganda. PARTICIPANTS 26 710 patient visits. RESULTS Procedures were performed for 65.6% of patients, predominantly intravenous cannulation, wound care, bladder catheterisation and orthopaedic procedures. Medications were administered to 87.6% of patients, most often pain medications, antibiotics, intravenous fluids, antimalarials, nutritional supplements and vaccinations. Laboratory testing was used for 85% of patients, predominantly malaria smears, rapid glucose testing, HIV assays, blood counts, urinalyses and blood type. Radiology testing was performed for 17.3% of patients, including X-rays, point-of-care ultrasound and formal ultrasound. CONCLUSION This study describes the skills and resources needed to care for a large prospective cohort of patients seen in a district hospital ED in rural sub-Saharan Africa. It demonstrates that the vast majority of patients were treated with a small formulary of critical medications and limited access to laboratories and imaging, but providers require a broad set of decision-making and procedural skills.
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Affiliation(s)
- Cindy Carol Bitter
- Division of Emergency Medicine, Department of Surgery, Saint Louis University, St. Louis, Missouri, USA
- Global Emergency Care
| | - Brian Rice
- Global Emergency Care
- Department of Emergency Medicine, New York University Langone Medical Center, New York City, New York, USA
| | - Usha Periyanayagam
- Global Emergency Care
- Harvard Humanitarian Initiative, Harvard University, Boston, Massachusetts, USA
| | - Bradley Dreifuss
- Global Emergency Care
- Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Heather Hammerstedt
- Global Emergency Care
- Department of Emergency Medicine, CEPA-Idaho, Boise, Idaho, USA
| | - Sara W Nelson
- Global Emergency Care
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Mark Bisanzo
- Global Emergency Care
- Division of Emergency Medicine, Department of Surgery, University of Vermont, Burlington, Vermont, USA
| | - Samuel Maling
- College of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stacey Chamberlain
- Global Emergency Care
- Department of Emergency Medicine and the Center for Global Health, University of Illinois, Chicago, Illinois, USA
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Mulwafu W, Chokotho L, Mkandawire N, Pandit H, Deckelbaum DL, Lavy C, Jacobsen KH. Trauma care in Malawi: A call to action. Malawi Med J 2018; 29:198-202. [PMID: 28955433 PMCID: PMC5610296 DOI: 10.4314/mmj.v29i2.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care. Studies in other low- and middle-income countries (LMICs) have demonstrated cost-effective methods for enhancing prehospital, in-hospital, and post-discharge care of trauma patients. We encourage health sectors leaders from across Malawi to take action to improve trauma care and reduce the burden from injury in this country.
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Affiliation(s)
- Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Nyengo Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Dan L Deckelbaum
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Oxford, United Kindgom
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
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Christmals CD, Gross J, Aziato L, Armstrong SJ. The State of Nursing Research in Ghana: An Integrative Literature Review. SAGE Open Nurs 2018; 4:2377960818783820. [PMID: 33415196 PMCID: PMC7774359 DOI: 10.1177/2377960818783820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/10/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For nursing practice to be responsive to the needs of patients, it must be driven by contextual research evidence. To guide institutional and national nursing research policy, there is need to determine the quantity and quality of nursing research in Ghana. PURPOSE The purpose of this integrative literature review was to quantify, critically evaluate, and describe nursing research publication in Ghana from January 2007 to December 2016 with regard to the country's research capacity to sustain evidence-based practice. RESULTS Sixty (60) out of 749 articles identified from EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar using three keywords (nursing, health, and Ghana) were included. A total of 60,778 human subjects were used in these studies. There were more quantitative (28) studies than qualitative (23) studies. These studies recorded 219 authors from 120 institutions, 55 of which were outside Ghana. Forty-five percent of the articles were published in journals with impact factor. There was a steady increase in publication in Ghana over the decade. A majority of the studies published in education were in curriculum implementation and evaluation. CONCLUSIONS The increasing number of peer-reviewed nursing research publications in Ghana and the curriculum implementation and evaluation in Ghana signified an increasing capacity of the country to implement and sustain evidence-based practice. RECOMMENDATIONS It is recommended that regular research be conducted to evaluate the responsiveness to old and new nursing programs in Ghana.
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Affiliation(s)
- Christmal D. Christmals
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg South Africa
| | - Janet Gross
- Morehead State University, KY, USA
- Global Health Services Partnership, US Peace Corps, Liberia
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Susan J. Armstrong
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Atakro CA. Differences and similarities of motivating and demotivating factors of emergency nursing care in rural and urban emergency units – A study of selected rural and urban emergency units in the Volta Region of Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Introduction This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified. METHODS Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported. RESULTS In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described. CONCLUSION The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services. Zakariah A , Stewart BT , Boateng E , Achena C , Tansley G , Mock C . The birth and growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83-93.
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Abstract
Introduction Road traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians. Problem This study examined the challenges associated with current first response practices in Malawi. METHODS In April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer. RESULTS Access to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services. CONCLUSION Prehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals. Chokotho L , Mulwafu W , Singini I , Njalale Y , Maliwichi-Senganimalunje L , Jacobsen KH . First responders and prehospital care for road traffic injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14-19.
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Gyedu A, Agbedinu K, Dalwai M, Osei-Ampofo M, Nakua EK, Oteng R, Stewart B. Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care. Pan Afr Med J 2016; 24:294. [PMID: 28154649 PMCID: PMC5267868 DOI: 10.11604/pamj.2016.24.294.8728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/02/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Methods Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Results Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Conclusion Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwabena Agbedinu
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mohammed Dalwai
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rockefeller Oteng
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Barclay Stewart
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
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Consensus recommendations for essential vascular care in low- and middle-income countries. J Vasc Surg 2016; 64:1770-1779.e1. [PMID: 27432199 DOI: 10.1016/j.jvs.2016.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. METHODS The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. RESULTS The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. CONCLUSIONS The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers.
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How Prepared Are Hospitals' Emergency Management Capacity? Factors Influencing Efficiency of Disaster Rescue. Disaster Med Public Health Prep 2016; 12:176-183. [PMID: 27189920 DOI: 10.1017/dmp.2016.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES In light of government investment over the past decade, we explored the capacity for disaster response in Heilongjiang Province, identifying the factors that affect response capacity. METHODS We surveyed 1257 medical staff in 65 secondary and tertiary hospitals in Heilongjiang province to explore their perceptions of disaster management capacity using a cross-sectional multistage, stratified cluster sampling method. RESULTS All tertiary hospitals (100%) and most secondary hospitals (93%) have documented disaster management plans that are regularly reviewed. In secondary hospitals, drills were less prevalent (76.7%) but the occurrence of simulated training exercises was closer to tertiary hospitals (86.0%). We noted that 95.4% of all hospitals have leadership groups responsible for disaster preparedness capacity building, but only 10.8% have a stockpiled network of reserve supplies. CONCLUSIONS Although response capacity has improved in Heilongjiang Province, vulnerabilities remain. We recommend that priorities should be targeted at preparedness capacity building, in terms of reliable and relevant operational response plans, the expansion of existing response mechanisms to oversee local education and scenario training, and to ensure there is sufficient access to protective equipment and materials, either held in reserve, or alternatively by activating resilient supply chain mechanisms. (Disaster Med Public Health Preparedness. 2018;12:176-183).
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Japiong KB, Asiamah G, Owusu-Dabo E, Donkor P, Stewart B, Ebel BE, Mock CN. Availability of resources for emergency care at a second-level hospital in Ghana: A mixed methods assessment. Afr J Emerg Med 2016; 6:30-37. [PMID: 30456061 PMCID: PMC6233235 DOI: 10.1016/j.afjem.2015.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Emergency care is an essential component of health systems, particularly in low- and middle-income countries. We sought to assess the availability of resources to provide emergency care at a second-level hospital in Ghana. By doing so, deficits that could guide development of targeted intervention strategies to improve emergency care could be identified. Methods A qualitative and quantitative assessment of capacity for care of emergency patients was performed at the Emergency Centre of the Police Hospital, a second-level hospital in Accra, Ghana. Direct inspection and job-specific survey of clinical, orderly, administrative and ambulance staff was performed. Responses to quantitative questions were described. Qualitative responses were examined by content analysis. Results Assessment revealed marked deficiencies in many essential items and services. However, several successes were identified, such as laboratory capacity. Among the unavailable essential items, some were of low-cost, such as basic airway supplies, chest tubes and several emergency medications. Themes from staff responses when asked how to improve emergency care included: provide periodic training, increase bed numbers in the emergency unit, ensure availability of essential items and make personal protective equipment available for all staff caring for patients. Conclusion This study identified opportunities to improve the care of patients with emergency conditions at the Police Hospital in Ghana. Low-cost improvements in training, organization and planning could improve item and service availability, such as: developing a continuing education curriculum for staff in all areas of the emergency centre; holding in-service training on existing protocols for triage and emergency care; adding checklists to guide appropriate triage and safe transfer of patients; and perform a root cause analysis of item non-availability to develop targeted interventions.
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Thurtle N, Banks C, Cox M, Pain T, Furyk J. Free Open Access Medical Education resource knowledge and utilisation amongst Emergency Medicine trainees: A survey in four countries. Afr J Emerg Med 2016; 6:12-17. [PMID: 30456058 PMCID: PMC6233238 DOI: 10.1016/j.afjem.2015.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/12/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
Introduction Free Open Access Medical Education encompasses a broad array of free online resources and discussion fora. The aim of this paper was to describe whether Emergency Medicine trainees in different contexts know about Free Open Access Medical Education, whether or not they know about its different platforms, which ones they use, and what the major barriers to regular usage are. Methods A convenience sample was surveyed on awareness and use of Free Open Access Medical Education blogs, podcasts, websites and Twitter at three institutions (in Australia, Botswana and Papua New Guinea) and one deanery (United Kingdom) between June 2013 and June 2014 using an online survey tool or via hand-distributed survey. Results 44 trainees responded: four from Botswana, seven from Papua New Guinea, ten from the United Kingdom and 23 from Australia. 82% were aware of blogs, 80% of websites, 75% of podcasts and 61% of Twitter as resources in Emergency Medicine. Awareness and use of specific resources were lower in Botswana and Papua New Guinea. For blogs, podcasts and websites, trainees who had looked at a resource at least once were neutral or agreed that it was relevant. For Twitter, some trainees found it difficult to navigate or not relevant. Lack of awareness of resources rather than lack of internet access was the main barrier to use. Conclusion The Emergency Medicine trainees in both developed and low resource settings studied were aware that Free Open Access Medical Education resources exist, but trainees in lower income settings were generally less aware of specific resources. Lack of internet and device access was not a barrier to use in this group.
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