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Agoubi LL, Issaka A, Sulaiman S, Gyedu A. Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana. Afr J Emerg Med 2024; 14:109-114. [PMID: 38756827 PMCID: PMC11096712 DOI: 10.1016/j.afjem.2024.04.001] [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: 10/13/2023] [Revised: 02/02/2024] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
Background The experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes. Methods This study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis. Results Of 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication. Conclusions An important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes.
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Affiliation(s)
- Lauren L. Agoubi
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Adamu Issaka
- Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Sakinah Sulaiman
- University of Buckingham Medical School, Buckingham, United Kingdom
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Henry JA, Madiraju SK, Mwai P, Hung YC, Chaker SC, Slater ED, Waiguru E, Jani P, Nthumba P. Scaling up Surgical Capacity in Kenya: The Kenya Hospital Assessment Tool (K-HAT). J Surg Res 2024; 295:800-810. [PMID: 38159336 DOI: 10.1016/j.jss.2023.12.001] [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] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Although substantial progress has been achieved to bring surgical care to the forefront of global health discussions, a number of low-and middle-income countries are still in the process of developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). This paper describes the initial step toward the development of the NSOAP through the creation of the Kenya National Hospital Assessment Tool (K-HAT). METHODS A study protocol was developed by a multisectoral collaborative group that represented the pillars of surgical capacity development in Kenya. The K-HAT was adapted from two World Health Organization (WHO) tools: the Service Availability and Readiness Assessment tool and the Situational Analysis Tool. The survey tool was deployed on Open Data Kit, an open-source electronic encrypted database. This new locally adapted tool was pilot tested in three hospitals in Kenya and subsequently deployed in Level 4 facilities. RESULTS Eighty-nine questions representing over 800 data points divided into six WHO Health Systems Strengthening sections comprised the K-HAT which was deployed to over 95% of Level 4 hospitals in Kenya. When compared to the WHO Service Availability and Readiness Assessment tool, the K-HAT collected more detailed information. The pilot test team reported that K-HAT was easy to administer, easily understood by the respondents, and that it took approximately 1 hour to collect data from each facility. CONCLUSIONS The K-HAT collected comprehensive information that can be used to develop Kenya's NSOAP.
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Affiliation(s)
- Jaymie Ang Henry
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas; International Collaboration for Essential Surgery, New York, New York
| | | | - Patrick Mwai
- International Collaboration for Essential Surgery, New York, New York; Department of Urology, University of Toledo Medical Center, Toledo, Ohio
| | - Ya-Ching Hung
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Sara C Chaker
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth D Slater
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Pankaj Jani
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Peter Nthumba
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
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Desalu I, Sarpong P, Osazuwa MO, Ndikontar Kwinji R, Faponle AF, Suleiman MK, Metogo Mbengono Epse Njoki J, Ilori I, Eyelade OR, Ohene AA, Anno A, Addison W. Global pediatric anesthesia-Anglophone West Africa perspective. Paediatr Anaesth 2024. [PMID: 38321802 DOI: 10.1111/pan.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/23/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services. FINDINGS Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non-physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith-based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric-specific operating theaters, and inadequate critical care services. SOLUTIONS The lack of opportunities for sub-specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non-governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed.
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Affiliation(s)
- Ibironke Desalu
- University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Raymond Ndikontar Kwinji
- Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| | - Aramide Folayemi Faponle
- Edward Francis Small Teaching Hospital, Banjul, Gambia
- University of The Gambia, Serrekunda, Gambia
| | - Musa Kallamu Suleiman
- Department Anesthesiology, Critical Care and Pain Management Department, John F Kennedy Medical Center, Monrovia, Liberia
- Dagliotti School of Medicine, University of Liberia, Monrovia, Liberia
| | - Junette Metogo Mbengono Epse Njoki
- Department for Intensive Care, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala, Cameroon
| | - Iniabasi Ilori
- University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | | | | | - William Addison
- Edward Francis Small Teaching Hospital, Banjul, Gambia
- University of The Gambia, Serrekunda, Gambia
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