Pub Date : 2025-01-14DOI: 10.1016/j.afjem.2024.10.229
Jonathan Kajjimu
The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.
{"title":"Global health research abstracts: January ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.229","DOIUrl":"10.1016/j.afjem.2024.10.229","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 545-547"},"PeriodicalIF":1.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.afjem.2024.10.224
Jonathan Kajjimu
The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.
{"title":"Global Health research abstracts: September ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.224","DOIUrl":"10.1016/j.afjem.2024.10.224","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 553-554"},"PeriodicalIF":1.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.afjem.2024.10.228
Jonathan Kajjimu
The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.
{"title":"Global health research abstracts: December ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.228","DOIUrl":"10.1016/j.afjem.2024.10.228","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 537-538"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.afjem.2024.10.226
Jonathan Kajjimu
The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.
{"title":"Global Health research abstracts: June ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.226","DOIUrl":"10.1016/j.afjem.2024.10.226","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 535-536"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-08DOI: 10.1016/j.afjem.2024.12.003
K Diango , J Pigoga , E Mafuta , J Yangongo , L Wallis , C Cunningham , P Hodkinson
Objective
Despite efforts in recent years to expand the availability of prehospital care in low- and middle-income countries, its availability remains limited in many regions. The World Health Organization advocates the development of layperson first responder programmes as a supportive step in building functioning prehospital systems. This study aimed to identify the need for, and acceptability of, a community first responder programme to increase out-of-hospital capacity in Kinshasa, Democratic Republic of Congo.
Methods
We conducted five focus group discussions using purposive sampling. We included health system planners, emergency care providers, community health volunteers, and community members in both urban and peri‑urban areas. Interviews were recorded and transcribed verbatim, validated, and subjected to inductive content analysis to identify themes and sub-themes.
Results
Several areas of the emergency care system were identified for improvement, starting with the initial response to emergencies in the community. Barriers included planning and governance issues; inadequate resources such as trained staff; cost; transportation issues; and reliance on alternative forms of care. There was a dominant view that sustainably addressing these barriers and building on identified facilitators requires a multi-pronged approach involving government, healthcare, and community members. Perspectives about the acceptability and sustainability of a community first responder programme were largely positive, and numerous actionable recommendations were provided.
Conclusion
A community first responder programme was deemed a useful and acceptable intervention to help increase out-of-hospital emergency care capacity in Kinshasa. Key potential facilitators and barriers to its implementation and sustainability were identified.
{"title":"Needs assessment and Acceptability of a Community First Aid Responder programme to increase Out-of-hospital capacity in Kinshasa, Democratic Republic of Congo: A qualitative study","authors":"K Diango , J Pigoga , E Mafuta , J Yangongo , L Wallis , C Cunningham , P Hodkinson","doi":"10.1016/j.afjem.2024.12.003","DOIUrl":"10.1016/j.afjem.2024.12.003","url":null,"abstract":"<div><h3>Objective</h3><div>Despite efforts in recent years to expand the availability of prehospital care in low- and middle-income countries, its availability remains limited in many regions. The World Health Organization advocates the development of layperson first responder programmes as a supportive step in building functioning prehospital systems. This study aimed to identify the need for, and acceptability of, a community first responder programme to increase out-of-hospital capacity in Kinshasa, Democratic Republic of Congo.</div></div><div><h3>Methods</h3><div>We conducted five focus group discussions using purposive sampling. We included health system planners, emergency care providers, community health volunteers, and community members in both urban and peri‑urban areas. Interviews were recorded and transcribed verbatim, validated, and subjected to inductive content analysis to identify themes and sub-themes.</div></div><div><h3>Results</h3><div>Several areas of the emergency care system were identified for improvement, starting with the initial response to emergencies in the community. Barriers included planning and governance issues; inadequate resources such as trained staff; cost; transportation issues; and reliance on alternative forms of care. There was a dominant view that sustainably addressing these barriers and building on identified facilitators requires a multi-pronged approach involving government, healthcare, and community members. Perspectives about the acceptability and sustainability of a community first responder programme were largely positive, and numerous actionable recommendations were provided.</div></div><div><h3>Conclusion</h3><div>A community first responder programme was deemed a useful and acceptable intervention to help increase out-of-hospital emergency care capacity in Kinshasa. Key potential facilitators and barriers to its implementation and sustainability were identified.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 526-534"},"PeriodicalIF":1.4,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-14DOI: 10.1016/j.afjem.2024.11.003
Julian T Hertz , Francis M Sakita , Wai Yan Min Htike , Kilonzo G Kajiru , Blandina T Mmbaga , Tumsifu G Tarimo , Godfrey L Kweka , Jerome J Mlangi , Amedeus V Maro , Lauren Coaxum , Sophie W Galson , Alexander T Limkakeng , Gerald S Bloomfield
<div><h3>Background</h3><div>Preliminary data suggests that the burden of acute coronary syndrome (ACS) is high in Tanzania. After efforts to improve ACS care, we sought to describe ACS diagnosis rates, care processes, and outcomes in a Tanzanian Emergency Department (ED).</div></div><div><h3>Methods</h3><div>Adults presenting to a northern Tanzanian ED with acute chest pain or shortness of breath were enrolled from November 2020 to January 2023. ACS was defined as per Fourth Universal Definition of Myocardial Infarct criteria. All treatments given in the ED were observed and recorded. Thirty-day follow-up was conducted with all participants via telephone or home visit.</div></div><div><h3>Results</h3><div>Of 568 participants with chest pain or shortness of breath, 129 (22.7 %) had ACS, including 61 (47 %) with STEMI and 68 (53 %) with non-STEMI. Of participants with ACS, 77 (59.7 %) were male, and the mean (SD) age was 64.5 (16.6) years. The mean duration of symptoms among ACS participants prior to presentation was 2.9 (3.0) days, and 26 (20.2 %) reported no known medical comorbidities. In the ED, 39 (30.2 %) participants with ACS received aspirin and 33 (25.6 %) received clopidogrel. Follow-up was achieved for all 129 ACS participants; 42 (32.6 %) of participants with ACS died within 30 days of presentation. Participants with ACS were significantly more likely to die within 30 days than participants without ACS (32.6 % vs 16.4 %, OR 2.45, 95 % CI: 1.56–3.83, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>ACS is common in a northern Tanzanian ED. Interventions are needed to improve uptake of evidence-based ACS care and reduce ACS-associated mortality.</div></div><div><h3>African relevance</h3><div><ul><li><span>•</span><span><div>The study found that 22.7 % of adults presenting with chest pain or shortness of breath in the Tanzanian emergency department (ED) had acute coronary syndrome (ACS). This high prevalence highlights the critical need for enhanced cardiovascular diagnostic and treatment capabilities in Tanzanian and similar African healthcare settings.</div></span></li><li><span>•</span><span><div>The research reveals significant challenges in managing ACS within resource-constrained settings, where limited access to advanced diagnostic tools like ECGs and cardiac biomarkers contributes to delayed or missed diagnoses, ultimately leading to worse patient outcomes. This situation reflects broader healthcare limitations across sub-Saharan Africa.</div></span></li><li><span>•</span><span><div>Thirty-day mortality among ACS patients in this study was extremely high (32.6 %), which is substantially higher than ACS mortality rates in high-income countries. These findings underscore the need for urgent interventions to address critical gaps in ACS care in African emergency departments.</div></span></li><li><span>•</span><span><div>By providing the first prospective data on ACS prevalence and outcomes in a Tanzanian ED, this stud
背景：初步数据表明，坦桑尼亚急性冠脉综合征（ACS）的负担很高。在努力改善ACS护理后，我们试图描述坦桑尼亚急诊科（ED）的ACS诊断率、护理过程和结果。方法：从2020年11月到2023年1月，在坦桑尼亚北部急诊科就诊的急性胸痛或呼吸短促的成年人被纳入研究。ACS的定义是根据心肌梗死标准的第四种通用定义。观察并记录急诊科给予的所有治疗。通过电话或家访对所有参与者进行了为期30天的随访。结果：在568名胸痛或呼吸短促的参与者中，129名（22.7%）患有ACS，包括61名（47%）STEMI和68名（53%）非STEMI。ACS患者中，男性77例（59.7%），平均（SD）年龄为64.5岁（16.6）岁。ACS参与者在发病前的平均症状持续时间为2.9（3.0）天，26（20.2%）报告没有已知的医学合并症。在ED中，39名（30.2%）ACS患者接受阿司匹林治疗，33名（25.6%）接受氯吡格雷治疗。对所有129名ACS参与者进行了随访；42例（32.6%）ACS患者在30天内死亡。ACS患者在30天内死亡的可能性明显高于无ACS患者（32.6% vs 16.4%, OR 2.45, 95% CI: 1.56-3.83, p < 0.001）。结论：ACS在坦桑尼亚北部急诊科很常见。需要采取干预措施，以提高循证ACS治疗的接受程度，降低ACS相关死亡率。非洲相关性：•研究发现，在坦桑尼亚急诊科（ED）出现胸痛或呼吸短促的成年人中，22.7%患有急性冠状动脉综合征（ACS）。这一高流行率凸显了坦桑尼亚和类似非洲卫生保健机构加强心血管诊断和治疗能力的迫切需要。•该研究揭示了在资源有限的环境下管理ACS的重大挑战，在这些环境中，像心电图和心脏生物标志物这样的先进诊断工具的获取有限，导致延迟或漏诊，最终导致患者预后更差。这种情况反映了整个撒哈拉以南非洲地区普遍存在的保健限制。•本研究中ACS患者的30天死亡率极高（32.6%），大大高于高收入国家的ACS死亡率。这些发现强调需要采取紧急干预措施，以解决非洲急诊科在ACS护理方面的严重差距。•通过提供坦桑尼亚ED中ACS患病率和结果的第一个前瞻性数据，本研究填补了区域流行病学知识的关键空白。这些见解对于为旨在减轻非洲心血管疾病负担的公共卫生战略提供信息至关重要。
{"title":"Acute coronary syndrome prevalence and outcomes in a Tanzanian emergency department: Results from a prospective surveillance study","authors":"Julian T Hertz , Francis M Sakita , Wai Yan Min Htike , Kilonzo G Kajiru , Blandina T Mmbaga , Tumsifu G Tarimo , Godfrey L Kweka , Jerome J Mlangi , Amedeus V Maro , Lauren Coaxum , Sophie W Galson , Alexander T Limkakeng , Gerald S Bloomfield","doi":"10.1016/j.afjem.2024.11.003","DOIUrl":"10.1016/j.afjem.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Preliminary data suggests that the burden of acute coronary syndrome (ACS) is high in Tanzania. After efforts to improve ACS care, we sought to describe ACS diagnosis rates, care processes, and outcomes in a Tanzanian Emergency Department (ED).</div></div><div><h3>Methods</h3><div>Adults presenting to a northern Tanzanian ED with acute chest pain or shortness of breath were enrolled from November 2020 to January 2023. ACS was defined as per Fourth Universal Definition of Myocardial Infarct criteria. All treatments given in the ED were observed and recorded. Thirty-day follow-up was conducted with all participants via telephone or home visit.</div></div><div><h3>Results</h3><div>Of 568 participants with chest pain or shortness of breath, 129 (22.7 %) had ACS, including 61 (47 %) with STEMI and 68 (53 %) with non-STEMI. Of participants with ACS, 77 (59.7 %) were male, and the mean (SD) age was 64.5 (16.6) years. The mean duration of symptoms among ACS participants prior to presentation was 2.9 (3.0) days, and 26 (20.2 %) reported no known medical comorbidities. In the ED, 39 (30.2 %) participants with ACS received aspirin and 33 (25.6 %) received clopidogrel. Follow-up was achieved for all 129 ACS participants; 42 (32.6 %) of participants with ACS died within 30 days of presentation. Participants with ACS were significantly more likely to die within 30 days than participants without ACS (32.6 % vs 16.4 %, OR 2.45, 95 % CI: 1.56–3.83, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>ACS is common in a northern Tanzanian ED. Interventions are needed to improve uptake of evidence-based ACS care and reduce ACS-associated mortality.</div></div><div><h3>African relevance</h3><div><ul><li><span>•</span><span><div>The study found that 22.7 % of adults presenting with chest pain or shortness of breath in the Tanzanian emergency department (ED) had acute coronary syndrome (ACS). This high prevalence highlights the critical need for enhanced cardiovascular diagnostic and treatment capabilities in Tanzanian and similar African healthcare settings.</div></span></li><li><span>•</span><span><div>The research reveals significant challenges in managing ACS within resource-constrained settings, where limited access to advanced diagnostic tools like ECGs and cardiac biomarkers contributes to delayed or missed diagnoses, ultimately leading to worse patient outcomes. This situation reflects broader healthcare limitations across sub-Saharan Africa.</div></span></li><li><span>•</span><span><div>Thirty-day mortality among ACS patients in this study was extremely high (32.6 %), which is substantially higher than ACS mortality rates in high-income countries. These findings underscore the need for urgent interventions to address critical gaps in ACS care in African emergency departments.</div></span></li><li><span>•</span><span><div>By providing the first prospective data on ACS prevalence and outcomes in a Tanzanian ED, this stud","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 518-525"},"PeriodicalIF":1.4,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1016/j.afjem.2024.11.001
Keabetsoe Hlanze , Kylen Swartzberg , Mike Wells
Background
Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.
Methods
A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.
Results
Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.
Conclusion
The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.
{"title":"Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa","authors":"Keabetsoe Hlanze , Kylen Swartzberg , Mike Wells","doi":"10.1016/j.afjem.2024.11.001","DOIUrl":"10.1016/j.afjem.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.</div></div><div><h3>Methods</h3><div>A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.</div></div><div><h3>Results</h3><div>Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.</div></div><div><h3>Conclusion</h3><div>The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 513-517"},"PeriodicalIF":1.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.afjem.2024.11.002
Hendry Robert Sawe
{"title":"Framework first: Key insights on developing emergency medical care policy in low- and middle-income countries","authors":"Hendry Robert Sawe","doi":"10.1016/j.afjem.2024.11.002","DOIUrl":"10.1016/j.afjem.2024.11.002","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 534-535"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.afjem.2024.10.222
Zoe Siegel , Trina Swanson , Emily Nyagaki , Adam R. Aluisio , Benjamin W. Wachira
Background and objectives
The Kenya Emergency Medical Care (EMC) Policy 2020–2030 was created to guide the advancement of EMC throughout Kenya. This report describes and maps the ongoing EMC policy development process across Kenya's 47 counties, serving as a real-world example of EMC policy development within a decentralized healthcare system in a low—or middle-income country (LMIC).
Methods
This report evaluates the development of county-specific EMC policies using the Kenya Institute for Public Policy Research and Analysis (KIPPRA) six stages for policy development: 1) problem identification, 2) agenda setting, 3) policy design, 4) approval, 5) implementation, and 6) monitoring and evaluation. Meeting minutes, workshop proceedings, and draft and final EMC policy documents were used to analyze the policy development process and provide a snapshot of current EMC policy statuses by county.
Results
As of August 2024, 23 counties have engaged in EMC policy development. Thirteen have finalized and are implementing their EMC policies, while 10 await approval. The remaining 24 counties are still in the planning stages. This process included gathering baseline emergency medical care standards to identify areas for improvement in each county. A core vision, mission, and goal aligned with the national policy were established and tailored to the county's needs. County-specific strategies were developed to address gaps between the existing system and national objectives. EMC policies were drafted, collaboratively reviewed, revised, and finalized before official approval. The next steps will be implementation, monitoring, and evaluation. Growth and improvement will be measured post-implementation based on baseline EMC metrics.
Conclusion
Kenya's strategy for EMC policy development across the 47 counties, utilizing KIPPRA's guidelines for public policy formulation, established a structured approach that included engaging stakeholders, conducting situational analyses, and aligning policy objectives with national goals. It is a comprehensive example of developing EMC policies for LMICs within decentralized healthcare systems.
{"title":"Developing emergency medical care policy across Kenya: A framework for policy development","authors":"Zoe Siegel , Trina Swanson , Emily Nyagaki , Adam R. Aluisio , Benjamin W. Wachira","doi":"10.1016/j.afjem.2024.10.222","DOIUrl":"10.1016/j.afjem.2024.10.222","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The Kenya Emergency Medical Care (EMC) Policy 2020–2030 was created to guide the advancement of EMC throughout Kenya. This report describes and maps the ongoing EMC policy development process across Kenya's 47 counties, serving as a real-world example of EMC policy development within a decentralized healthcare system in a low—or middle-income country (LMIC).</div></div><div><h3>Methods</h3><div>This report evaluates the development of county-specific EMC policies using the Kenya Institute for Public Policy Research and Analysis (KIPPRA) six stages for policy development: 1) problem identification, 2) agenda setting, 3) policy design, 4) approval, 5) implementation, and 6) monitoring and evaluation. Meeting minutes, workshop proceedings, and draft and final EMC policy documents were used to analyze the policy development process and provide a snapshot of current EMC policy statuses by county.</div></div><div><h3>Results</h3><div>As of August 2024, 23 counties have engaged in EMC policy development. Thirteen have finalized and are implementing their EMC policies, while 10 await approval. The remaining 24 counties are still in the planning stages. This process included gathering baseline emergency medical care standards to identify areas for improvement in each county. A core vision, mission, and goal aligned with the national policy were established and tailored to the county's needs. County-specific strategies were developed to address gaps between the existing system and national objectives. EMC policies were drafted, collaboratively reviewed, revised, and finalized before official approval. The next steps will be implementation, monitoring, and evaluation. Growth and improvement will be measured post-implementation based on baseline EMC metrics.</div></div><div><h3>Conclusion</h3><div>Kenya's strategy for EMC policy development across the 47 counties, utilizing KIPPRA's guidelines for public policy formulation, established a structured approach that included engaging stakeholders, conducting situational analyses, and aligning policy objectives with national goals. It is a comprehensive example of developing EMC policies for LMICs within decentralized healthcare systems.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 527-533"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.afjem.2024.12.001
Marcus William Kruger , Jana du Plessis , Pravani Moodley
Introduction
Unstable pelvic fractures cause significant bleeding, morbidity, and mortality. Commercially available Pelvic Circumferential Compression Devices (PCCDs) are used in the initial resuscitation and management of these cases. In the trauma-burdened, resource limited setting of Southern Africa, the available alternative is a pelvic sheet binder (PSB). For optimal results placement should be at the greater trochanters (GTs). Prior studies have shown that practitioners are inaccurate in their placement. This study aimed to describe placement of PSBs by doctors and factors influencing placement.
Methods
This was a multicentre, prospective, observational, simulation-based study. Doctors working in Emergency Departments (EDs) and Trauma Emergency Units (TEUs) in Johannesburg were asked to place a PSB on two healthy male models of differing body mass index (BMI), as simulated patients (SPs). Outcomes were based on PSB position relative to the GTs, marked using an ultraviolet pen, and photographed under ultraviolet light. Data on techniques of placement, as well as practitioner factors, were also collected to investigate their influence on accuracy.
Results
In this study 147/176 (83.5 %) of the PSBs placed were correct (trochanteric). Of those placed on the normal BMI SP 71/88 (81 %) were correct and 76/88 (86 %) of those on the increased BMI SP. BMI did not appear to influence accuracy of placement. Practitioner factors that had statistically significant association with accurate placement included the following: Working in the TEU, work experience of ≥6 years, a diploma in primary emergency care (DipPEC, College of emergency medicine, South Africa), all methods of placing the PSB and inspecting to find the GTs.
Conclusion
The overall accuracy of PSBs placement was high (83.5 %). Additional postgraduate training (DipPEC) and work experience improved placement accuracy. This study highlighted the importance of additional trauma training and areas of possible future research, such as optimal binder width and method of securing PSBs.
{"title":"Pelvic sheet binders: Are doctors placing them in the correct position?","authors":"Marcus William Kruger , Jana du Plessis , Pravani Moodley","doi":"10.1016/j.afjem.2024.12.001","DOIUrl":"10.1016/j.afjem.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Unstable pelvic fractures cause significant bleeding, morbidity, and mortality. Commercially available Pelvic Circumferential Compression Devices (PCCDs) are used in the initial resuscitation and management of these cases. In the trauma-burdened, resource limited setting of Southern Africa, the available alternative is a pelvic sheet binder (PSB). For optimal results placement should be at the greater trochanters (GTs). Prior studies have shown that practitioners are inaccurate in their placement. This study aimed to describe placement of PSBs by doctors and factors influencing placement.</div></div><div><h3>Methods</h3><div>This was a multicentre, prospective, observational, simulation-based study. Doctors working in Emergency Departments (EDs) and Trauma Emergency Units (TEUs) in Johannesburg were asked to place a PSB on two healthy male models of differing body mass index (BMI), as simulated patients (SPs). Outcomes were based on PSB position relative to the GTs, marked using an ultraviolet pen, and photographed under ultraviolet light. Data on techniques of placement, as well as practitioner factors, were also collected to investigate their influence on accuracy.</div></div><div><h3>Results</h3><div>In this study 147/176 (83.5 %) of the PSBs placed were correct (trochanteric). Of those placed on the normal BMI SP 71/88 (81 %) were correct and 76/88 (86 %) of those on the increased BMI SP. BMI did not appear to influence accuracy of placement. Practitioner factors that had statistically significant association with accurate placement included the following: Working in the TEU, work experience of ≥6 years, a diploma in primary emergency care (DipPEC, College of emergency medicine, South Africa), all methods of placing the PSB and inspecting to find the GTs.</div></div><div><h3>Conclusion</h3><div>The overall accuracy of PSBs placement was high (83.5 %). Additional postgraduate training (DipPEC) and work experience improved placement accuracy. This study highlighted the importance of additional trauma training and areas of possible future research, such as optimal binder width and method of securing PSBs.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 512-517"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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