Pub Date : 2025-09-18DOI: 10.1016/j.afjem.2025.100907
Daniel Gyaase , Deepti Beri , Stacie Powell , Nipuna Cooray , Margie Peden , Julie Brown , Jagnoor Jagnoor
Background
In Ghana, there is a lack of comprehensive and empirical data on injuries. In the absence of robust national datasets, systematic reviews serve as a critical tool for understanding existing evidence. Our study synthesises the available literature to estimate the pooled prevalence and mortality associated with unintentional injuries in Ghana.
Method
We searched and identified studies that reported on the burden (prevalence, mortality, economic and disabilities) of commonly reported unintentional injuries (road traffic injuries, falls, burns, drowning and poisoning) in Ghana. Studies were identified from PubMed, EMBASE, Global Health, and Scopus from 2000 to 2023.
Result
A total of 46 studies were included in the review. The prevalence and mortality of unintentional injuries were high, with a pooled estimate of 18 % (95 % CI: 11 % – 26 %) and 15 % (9 % CI: 10 % – 21 %), respectively. Road traffic injury (RTI) was found to be a major contributor to the high prevalence and mortality. Our review found limited data on the economic burden and disabilities from unintentional injuries. Despite the lack of complete data, the cost of treating unintentional injuries appears to be significantly high. The annual cost of treating RTIs was US$6730,862.89, falls were US$1645,736.50, and burns were US$464,937.11.
Conclusion
Our review found a high prevalence, mortality, and likely economic burden of unintentional injuries in Ghana. Prioritising road safety could significantly reduce the burden of unintentional injuries in Ghana. Due to the limited studies on the economic burden and disability from unintentional injuries, more research is needed to drive insurance policies and rehabilitation practices.
{"title":"Examining the burden of unintentional injuries in Ghana: A systematic review and meta-analysis","authors":"Daniel Gyaase , Deepti Beri , Stacie Powell , Nipuna Cooray , Margie Peden , Julie Brown , Jagnoor Jagnoor","doi":"10.1016/j.afjem.2025.100907","DOIUrl":"10.1016/j.afjem.2025.100907","url":null,"abstract":"<div><h3>Background</h3><div>In Ghana, there is a lack of comprehensive and empirical data on injuries. In the absence of robust national datasets, systematic reviews serve as a critical tool for understanding existing evidence. Our study synthesises the available literature to estimate the pooled prevalence and mortality associated with unintentional injuries in Ghana.</div></div><div><h3>Method</h3><div>We searched and identified studies that reported on the burden (prevalence, mortality, economic and disabilities) of commonly reported unintentional injuries (road traffic injuries, falls, burns, drowning and poisoning) in Ghana. Studies were identified from PubMed, EMBASE, Global Health, and Scopus from 2000 to 2023.</div></div><div><h3>Result</h3><div>A total of 46 studies were included in the review. The prevalence and mortality of unintentional injuries were high, with a pooled estimate of 18 % (95 % CI: 11 % – 26 %) and 15 % (9 % CI: 10 % – 21 %), respectively. Road traffic injury (RTI) was found to be a major contributor to the high prevalence and mortality. Our review found limited data on the economic burden and disabilities from unintentional injuries. Despite the lack of complete data, the cost of treating unintentional injuries appears to be significantly high. The annual cost of treating RTIs was US$6730,862.89, falls were US$1645,736.50, and burns were US$464,937.11.</div></div><div><h3>Conclusion</h3><div>Our review found a high prevalence, mortality, and likely economic burden of unintentional injuries in Ghana. Prioritising road safety could significantly reduce the burden of unintentional injuries in Ghana. Due to the limited studies on the economic burden and disability from unintentional injuries, more research is needed to drive insurance policies and rehabilitation practices.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100907"},"PeriodicalIF":1.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-18DOI: 10.1016/j.afjem.2025.100908
Esther Cloete , Jacobus J Badenhorst , Anthony R Reed
Background
Ventilated patients in the operating theatre who need transfer to other facilities, can contribute to delays and inefficencies in surgical and theatre resources. In 2018, an interhospital retrieval service was established to provide transfers between state hospitals in the Cape Town Metropole exclusively for intubated, post-operative patients. This study aims to describe the utilisation of the retrieval system and gain insights into retrieval patterns.
Methods
This retrospective observational study analysed all post-operative patients using the retrieval system between state hospitals in the Cape Town Metropole from July 2018 – December 2021, as recorded in an existing SPRINTT-OR registry.
Results
A total of 291 patients were included. Most patients retrieved were male (n = 186, 63.9 %), with a mean age of 34.95 (S ± 13.59). The median time interval from request to ambulance arrival was 61 min. Most patients (n = 184, 63.2 %) were transferred from a single Large Metro District Hospital (LMDH). Trauma surgery was the most common diagnostic category (n = 123, 42.3 %), followed by infective causes (n = 79, 27.1 %) and Obstetrics & Gynaecology (n = 52, 17.9 %).
Conclusion
This study provides insight into the retrieval needs of ventilated, post-operative patients across different healthcare facilities in an African metropolitan area who are transferred with a dedicated, specialised transfer service. It describes the system's use and provides insight into patient demographics, diagnoses, and transfer timing, as well as the role of Emergency Medical Services (EMS) in optimising the functioning of a healthcare system.
{"title":"Critical care transfers of ventilator-dependent patients from operating theatres to Critical Care Units in a South African Metropole","authors":"Esther Cloete , Jacobus J Badenhorst , Anthony R Reed","doi":"10.1016/j.afjem.2025.100908","DOIUrl":"10.1016/j.afjem.2025.100908","url":null,"abstract":"<div><h3>Background</h3><div>Ventilated patients in the operating theatre who need transfer to other facilities, can contribute to delays and inefficencies in surgical and theatre resources. In 2018, an interhospital retrieval service was established to provide transfers between state hospitals in the Cape Town Metropole exclusively for intubated, post-operative patients. This study aims to describe the utilisation of the retrieval system and gain insights into retrieval patterns.</div></div><div><h3>Methods</h3><div>This retrospective observational study analysed all post-operative patients using the retrieval system between state hospitals in the Cape Town Metropole from July 2018 – December 2021, as recorded in an existing SPRINTT-OR registry.</div></div><div><h3>Results</h3><div>A total of 291 patients were included. Most patients retrieved were male (<em>n</em> = 186, 63.9 %), with a mean age of 34.95 (<em>S</em> ± 13.59). The median time interval from request to ambulance arrival was 61 min. Most patients (<em>n</em> = 184, 63.2 %) were transferred from a single Large Metro District Hospital (LMDH). Trauma surgery was the most common diagnostic category (<em>n</em> = 123, 42.3 %), followed by infective causes (<em>n</em> = 79, 27.1 %) and Obstetrics & Gynaecology (<em>n</em> = 52, 17.9 %).</div></div><div><h3>Conclusion</h3><div>This study provides insight into the retrieval needs of ventilated, post-operative patients across different healthcare facilities in an African metropolitan area who are transferred with a dedicated, specialised transfer service. It describes the system's use and provides insight into patient demographics, diagnoses, and transfer timing, as well as the role of Emergency Medical Services (EMS) in optimising the functioning of a healthcare system.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100908"},"PeriodicalIF":1.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.afjem.2025.100903
Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo
Introduction
Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.
Methods
A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.
Results
Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.
Discussion
Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies
{"title":"Nurses’ knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana","authors":"Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo","doi":"10.1016/j.afjem.2025.100903","DOIUrl":"10.1016/j.afjem.2025.100903","url":null,"abstract":"<div><h3>Introduction</h3><div>Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.</div></div><div><h3>Results</h3><div>Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.</div></div><div><h3>Discussion</h3><div>Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100903"},"PeriodicalIF":1.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.afjem.2025.100902
Arthi Kozhumam , Shazmah Suleman , Vihar Kotecha , Doug Lorenz , Charles Uttoh , Rebecca Yalimo , Colleen Fant
Introduction
Despite a high burden of paediatric injury (25 % of all presenting injuries) in Tanzanian studies, literature remains limited, especially in recent years, regarding detail of care provided for the injured child across different healthcare settings in the country. This study aims to understand and map the pediatric trauma burden and factors descriptively associated with pediatric injury at the zonal referral hospital, Bugando Medical Center (BMC), for northwestern Tanzania.
Methods
This study was a subgroup cross-sectional analysis of paediatric (ages 0 through 17) data collected from trauma patients who received care at BMC from March - August 2023, focused on paediatric-specific injury occurrence, injury characteristics, and location. Descriptive analyses of paediatric patient demographics, past medical history, prehospital characteristics, and injury characteristics across body system were conducted to understand the burden of serious injury in this setting. Geospatial analyses across region were conducted to understand patient density, triage level, prehospital care, and Euclidean distance from injury region to BMC.
Results
146 children were included in analysis. Almost all children were injured at home (42.5 %) or in a traffic crash (33.6 %), with more than half (56.8 %) in the highest (red) triage category. Nearly 70 % had received prehospital care from a healthcare professional. Head and maxillo-facial injuries were most the most common. Distance from Bugando Medical Center was associated with higher triage level but not with prehospital care.
Discussion
Paediatric injury in this referral hospital in northwestern Tanzania has distinct variations in referral patterns, injury locations and injury types. Efforts are particularly needed for head and maxillo-facial emergency support due to the predominance of injuries to these body systems. Regional variations in paediatric trauma incidence may represent a future target for outreach from this referral institution.
{"title":"Demographics of paediatric trauma at a zonal referral hospital for northwestern Tanzania: A cross-sectional study","authors":"Arthi Kozhumam , Shazmah Suleman , Vihar Kotecha , Doug Lorenz , Charles Uttoh , Rebecca Yalimo , Colleen Fant","doi":"10.1016/j.afjem.2025.100902","DOIUrl":"10.1016/j.afjem.2025.100902","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite a high burden of paediatric injury (25 % of all presenting injuries) in Tanzanian studies, literature remains limited, especially in recent years, regarding detail of care provided for the injured child across different healthcare settings in the country. This study aims to understand and map the pediatric trauma burden and factors descriptively associated with pediatric injury at the zonal referral hospital, Bugando Medical Center (BMC), for northwestern Tanzania.</div></div><div><h3>Methods</h3><div>This study was a subgroup cross-sectional analysis of paediatric (ages 0 through 17) data collected from trauma patients who received care at BMC from March - August 2023, focused on paediatric-specific injury occurrence, injury characteristics, and location. Descriptive analyses of paediatric patient demographics, past medical history, prehospital characteristics, and injury characteristics across body system were conducted to understand the burden of serious injury in this setting. Geospatial analyses across region were conducted to understand patient density, triage level, prehospital care, and Euclidean distance from injury region to BMC.</div></div><div><h3>Results</h3><div>146 children were included in analysis. Almost all children were injured at home (42.5 %) or in a traffic crash (33.6 %), with more than half (56.8 %) in the highest (red) triage category. Nearly 70 % had received prehospital care from a healthcare professional. Head and maxillo-facial injuries were most the most common. Distance from Bugando Medical Center was associated with higher triage level but not with prehospital care.</div></div><div><h3>Discussion</h3><div>Paediatric injury in this referral hospital in northwestern Tanzania has distinct variations in referral patterns, injury locations and injury types. Efforts are particularly needed for head and maxillo-facial emergency support due to the predominance of injuries to these body systems. Regional variations in paediatric trauma incidence may represent a future target for outreach from this referral institution.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100902"},"PeriodicalIF":1.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-13DOI: 10.1016/j.afjem.2025.100904
Marvin Jansen, Fahmi Adams
Africa's emergency medicine training faces challenges of limited resources, inadequate simulation tools, and few locally relevant training models. This article explores how three-dimensional (3D) printing can help address these gaps by enabling the creation of affordable, customizable models for procedural skills and simulation-based education. We discuss the context of emergency medicine training in Africa, where limited access to high-fidelity manikins and other teaching aids hampers skills acquisition. The model printing format may be of limited applicability in the context of dynamic simulations, where the model is required to interact and perform a function, versus static simulation, with the emphasis on identification and directed procedures. We highlight illustrative use cases, including a 3D-printed airway management manikin and a basic suturing practice pad, to demonstrate the technology’s potential for hands-on learning. Key benefits of integrating 3D printing into training programs are examined, such as improved access to simulation, better local adaptability, and increased opportunity for producing affordable task trainers that are suited for hands-on emergency procedures. We also acknowledge challenges, from startup costs and infrastructure needs to the learning curve of 3D printers and suggest practical steps for implementation. This commentary encourages educators and institutions in Africa to explore 3D printing for education, and we envision it becoming integral to emergency medicine training across the continent; fostering skill development, self-sufficiency, and ultimately improving patient care.
{"title":"Embracing 3D printing in emergency medicine training in Africa","authors":"Marvin Jansen, Fahmi Adams","doi":"10.1016/j.afjem.2025.100904","DOIUrl":"10.1016/j.afjem.2025.100904","url":null,"abstract":"<div><div>Africa's emergency medicine training faces challenges of limited resources, inadequate simulation tools, and few locally relevant training models. This article explores how three-dimensional (3D) printing can help address these gaps by enabling the creation of affordable, customizable models for procedural skills and simulation-based education. We discuss the context of emergency medicine training in Africa, where limited access to high-fidelity manikins and other teaching aids hampers skills acquisition. The model printing format may be of limited applicability in the context of dynamic simulations, where the model is required to interact and perform a function, versus static simulation, with the emphasis on identification and directed procedures. We highlight illustrative use cases, including a 3D-printed airway management manikin and a basic suturing practice pad, to demonstrate the technology’s potential for hands-on learning. Key benefits of integrating 3D printing into training programs are examined, such as improved access to simulation, better local adaptability, and increased opportunity for producing affordable task trainers that are suited for hands-on emergency procedures. We also acknowledge challenges, from startup costs and infrastructure needs to the learning curve of 3D printers and suggest practical steps for implementation. This commentary encourages educators and institutions in Africa to explore 3D printing for education, and we envision it becoming integral to emergency medicine training across the continent; fostering skill development, self-sufficiency, and ultimately improving patient care.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100904"},"PeriodicalIF":1.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-09DOI: 10.1016/j.afjem.2025.100892
Boris Arnaud Nteungue Kouomogne , Bissouma-Ledjou Tania , Chanceline Bilounga Ndongo , Alvine Choula Noulala , Hyppolite Kalambay Ntembwa , Pierre Claver Kariyo , Baonga Ba Pouth , Douba Epée , Bitang Louis Joss , Bertolt Brecht Kouam Nteungue , Dieudonnée Reine Ndougou , Mochache Trufosa , Simon Tumusiime , Ambomo Sylvie Myriam , Lauren Lai King , Annet Ngabirano Alenyo , Antoinette Naidoo , Linda Endale Esso , Yap Boum , Habimana Phanuel , Lee Wallis
Background
Globally, the demand for acute care is surging, disproportionately burdening low- and middle-income countries. Training for healthcare providers can play a pivotal role in reducing related mortality and improving overall health and well-being, particularly in sub-Saharan Africa. Despite the potential for impact, the World Health Organization- International Committee of the Red Cross (WHO-ICRC) Basic Emergency Care (BEC) course is yet to be fully rolled out in Francophone African nations such as Cameroon, Djibouti, Haiti, Morocco, and Tunisia. In this paper, we describe the introduction of this training in these countries.
Methods
This study utilized pre- and post-course surveys to gauge change in knowledge and confidence in delivering acute care. A comprehensive 4-day French BEC course and a concise 1-day Training of Trainer (ToT) course were delivered in Yaounde, Cameroon, in early 2023. Participants undertook surveys pre- and post-training, offering insights into their acute care knowledge, skills, and self-assurance.
Results
The courses were attended by 50 participants. The post-course evaluation highlighted a marked improvement in scores, showcasing a median score elevation from 72% pre-course to 88% post-course (p < 0.001). Participants’ self-confidence in handling acute care scenarios doubled. Universal acclaim was received for the quality of training materials, courses, and facilitation methodology, with nearly half feeling no amendment was necessary in the course design. However, 30% felt a longer duration should be dedicated to the practical/skills components of the course.
Conclusions
The WHO-ICRC BEC course significantly enhanced the acute care knowledge, skills, and self-confidence of participants from these five countries, laying a solid foundation for future training sessions. Provisional trainers are now proficient in expanding such training within their regions. Evaluating patient outcomes post-training presents significant challenges, highlighting a crucial area for future research and scrutiny.
{"title":"Improving emergency care capacity with the WHO-ICRC Basic Emergency Care (BEC) course","authors":"Boris Arnaud Nteungue Kouomogne , Bissouma-Ledjou Tania , Chanceline Bilounga Ndongo , Alvine Choula Noulala , Hyppolite Kalambay Ntembwa , Pierre Claver Kariyo , Baonga Ba Pouth , Douba Epée , Bitang Louis Joss , Bertolt Brecht Kouam Nteungue , Dieudonnée Reine Ndougou , Mochache Trufosa , Simon Tumusiime , Ambomo Sylvie Myriam , Lauren Lai King , Annet Ngabirano Alenyo , Antoinette Naidoo , Linda Endale Esso , Yap Boum , Habimana Phanuel , Lee Wallis","doi":"10.1016/j.afjem.2025.100892","DOIUrl":"10.1016/j.afjem.2025.100892","url":null,"abstract":"<div><h3>Background</h3><div>Globally, the demand for acute care is surging, disproportionately burdening low- and middle-income countries. Training for healthcare providers can play a pivotal role in reducing related mortality and improving overall health and well-being, particularly in sub-Saharan Africa. Despite the potential for impact, the World Health Organization- International Committee of the Red Cross <u>(</u>WHO-ICRC) Basic Emergency Care (BEC) course is yet to be fully rolled out in Francophone African nations such as Cameroon, Djibouti, Haiti, Morocco, and Tunisia. In this paper, we describe the introduction of this training in these countries.</div></div><div><h3>Methods</h3><div>This study utilized pre- and post-course surveys to gauge change in knowledge and confidence in delivering acute care. A comprehensive 4-day French BEC course and a concise 1-day Training of Trainer (ToT) course were delivered in Yaounde, Cameroon, in early 2023. Participants undertook surveys pre- and post-training, offering insights into their acute care knowledge, skills, and self-assurance.</div></div><div><h3>Results</h3><div>The courses were attended by 50 participants. The post-course evaluation highlighted a marked improvement in scores, showcasing a median score elevation from 72% pre-course to 88% post-course (p < 0.001). Participants’ self-confidence in handling acute care scenarios doubled. Universal acclaim was received for the quality of training materials, courses, and facilitation methodology, with nearly half feeling no amendment was necessary in the course design. However, 30% felt a longer duration should be dedicated to the practical/skills components of the course.</div></div><div><h3>Conclusions</h3><div>The WHO-ICRC BEC course significantly enhanced the acute care knowledge, skills, and self-confidence of participants from these five countries, laying a solid foundation for future training sessions. Provisional trainers are now proficient in expanding such training within their regions. Evaluating patient outcomes post-training presents significant challenges, highlighting a crucial area for future research and scrutiny.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100892"},"PeriodicalIF":1.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1016/j.afjem.2025.100900
Naseef Abdullah , Tim Nutbeam , Colleen J. Saunders , Craig Wylie , Nigel Lang , Willem Stassen
Introduction
Road traffic injuries constitute a significant global health burden, causing 1.3 million deaths and 50 million injuries annually, with 92 % of fatalities occurring in low-and middle-income countries (LMICs). Despite this disproportionate impact, research priorities in post-collision care often reflect high-income country contexts, creating a critical misalignment between evidence generation and contextual realities in LMICs.
Methods
This mixed-methods study employed a three-phase approach to identify research priorities for post-collision care in the Western Cape, South Africa. Phase 1 consisted of a comprehensive literature review to identify preliminary thematic areas and research questions. Phase 2 involved a stakeholder engagement workshop using modified nominal group techniques (NGT) with purposively sampled participants representing emergency medical services, fire services, law enforcement, community members and academia. Phase 3 entailed systematic prioritisation, where participants independently scored each theme and associated research questions on a Likert scale.
Results
Eight thematic domains were identified and ranked in order of priority. EMS safety (highest priority), communication and coordination, public awareness and prevention, transportation and access to care, first-responder capabilities, training implementation, resource optimisation, disaster and mass casualty management, and specialised care accessibility. The highest-ranked individual research question concerned the minimum set of practical skills and resources required by first responders to effectively provide immediate post-collision care. Technological integration emerged as a cross-cutting priority across multiple themes.
Conclusion
The study represents the first published systematic approach to identifying post-collision care research priorities in South Africa. Diverging from previous exercises that emphasise advanced interventions or system integration, this study highlights foundational challenges of EMS safety and communication as top priorities, reflecting the contextual realities of emergency service delivery in South Africa. The findings provide a strategic roadmap for researchers, funders, and policymakers to direct resources toward questions with maximal potential to improve post-collision care and strengthen health systems in similar LMIC contexts.
{"title":"Consensus-based research priorities for post-collision care in the Western Cape province of South Africa","authors":"Naseef Abdullah , Tim Nutbeam , Colleen J. Saunders , Craig Wylie , Nigel Lang , Willem Stassen","doi":"10.1016/j.afjem.2025.100900","DOIUrl":"10.1016/j.afjem.2025.100900","url":null,"abstract":"<div><h3>Introduction</h3><div>Road traffic injuries constitute a significant global health burden, causing 1.3 million deaths and 50 million injuries annually, with 92 % of fatalities occurring in low-and middle-income countries (LMICs). Despite this disproportionate impact, research priorities in post-collision care often reflect high-income country contexts, creating a critical misalignment between evidence generation and contextual realities in LMICs.</div></div><div><h3>Methods</h3><div>This mixed-methods study employed a three-phase approach to identify research priorities for post-collision care in the Western Cape, South Africa. Phase 1 consisted of a comprehensive literature review to identify preliminary thematic areas and research questions. Phase 2 involved a stakeholder engagement workshop using modified nominal group techniques (NGT) with purposively sampled participants representing emergency medical services, fire services, law enforcement, community members and academia. Phase 3 entailed systematic prioritisation, where participants independently scored each theme and associated research questions on a Likert scale.</div></div><div><h3>Results</h3><div>Eight thematic domains were identified and ranked in order of priority. EMS safety (highest priority), communication and coordination, public awareness and prevention, transportation and access to care, first-responder capabilities, training implementation, resource optimisation, disaster and mass casualty management, and specialised care accessibility. The highest-ranked individual research question concerned the minimum set of practical skills and resources required by first responders to effectively provide immediate post-collision care. Technological integration emerged as a cross-cutting priority across multiple themes.</div></div><div><h3>Conclusion</h3><div>The study represents the first published systematic approach to identifying post-collision care research priorities in South Africa. Diverging from previous exercises that emphasise advanced interventions or system integration, this study highlights foundational challenges of EMS safety and communication as top priorities, reflecting the contextual realities of emergency service delivery in South Africa. The findings provide a strategic roadmap for researchers, funders, and policymakers to direct resources toward questions with maximal potential to improve post-collision care and strengthen health systems in similar LMIC contexts.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100900"},"PeriodicalIF":1.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.afjem.2025.100897
Shannon Pillay, Bavani Naicker, Kamlin Ekambaram
Background
Despite advances in both pharmacological and non-pharmacological pain management, children remain vulnerable to oligoanalgesia. Understanding clinical practices and barriers encountered by treating clinicians is essential to inform targeted interventions. This study aimed to examine knowledge, attitudes and reported practices of doctors managing acute paediatric pain in rural regional hospitals in KwaZulu-Natal, South Africa.
Methods
An electronic survey was distributed between January and February 2024 to doctors working in the departments of Emergency Medicine, Paediatrics, Surgery, and Orthopaedics at three regional hospitals. The survey included both closed- and open-ended questions addressing analgesic choices, awareness of clinical protocols, and perceived barriers to effective pain management. Descriptive statistics were used to summarise overall trends. Post hoc subgroup analyses were conducted using Chi-square and Fisher’s exact tests. Odds ratios were calculated to describe significant associations.
Results
Of 165 clinicians approached, 131 responded (response rate: 80%). Over half (55.7%) reported inadequate training for paediatric pain management, and only 42% were aware of departmental protocols. Paracetamol was the most commonly used analgesic agent. Key barriers included time constraints, limited drug access, and departmental culture. Awareness of departmental paediatric pain protocols was highest (82,9%) in Paediatrics (χ², p<0.001). Paediatric doctors reported significantly greater use of non-pharmacological methods across multiple conditions and procedures. Emergency Medicine respondents more frequently reported opioids for severe abdominal pain (OR=4.24, p<0.001, 95% CI 1.96-9.14). Barriers varied by discipline. Paediatrics cited difficulties with pain assessment, while Orthopaedics primarily reported time and staffing constraints.
Conclusion
Paediatric pain remains common yet inadequately addressed in Southern Africa. This study identifies insufficient training, poor access to analgesia, and departmental practices as key barriers. Context-specific, cost-effective, multimodal strategies and tailored education are needed to improve care. Sustainable progress requires cultural change, better training, and interdisciplinary collaboration to ensure equitable pain management.
尽管在药物和非药物疼痛管理方面都取得了进展，但儿童仍然容易受到少效镇痛的影响。了解临床实践和治疗临床医生遇到的障碍对于告知有针对性的干预措施至关重要。本研究旨在检查知识，态度和报告的医生在夸祖鲁-纳塔尔省农村地区医院管理急性儿科疼痛的做法，南非。方法于2024年1 - 2月对3家地区医院急诊科、儿科、外科和骨科的医生进行电子调查。该调查包括封闭和开放式问题，涉及止痛药的选择，临床协议的认识，以及有效疼痛管理的感知障碍。描述性统计用于总结总体趋势。事后亚组分析采用卡方检验和Fisher精确检验。计算比值比来描述显著相关性。结果165名临床医生中，131名有反应（有效率：80%）。超过一半（55.7%）的人报告儿科疼痛管理培训不足，只有42%的人知道部门协议。对乙酰氨基酚是最常用的镇痛药。主要障碍包括时间限制、药物获取受限和部门文化。儿科对科室儿科疼痛方案的知晓率最高（82.9%）（χ²，p<0.001）。儿科医生报告说，在多种情况和程序中，非药物方法的使用明显增加。急诊医学受访者更频繁地报告阿片类药物治疗严重腹痛（OR=4.24, p<0.001, 95% CI 1.96-9.14）。障碍因学科而异。儿科提到疼痛评估的困难，而骨科主要报告时间和人员限制。结论：在南部非洲，儿童疼痛仍然很常见，但尚未得到充分解决。本研究确定培训不足、难以获得镇痛药和部门实践是主要障碍。需要针对具体情况、具有成本效益的多模式战略和量身定制的教育来改善护理。可持续发展需要文化变革、更好的培训和跨学科合作，以确保公平的疼痛管理。
{"title":"Acute paediatric pain management: A survey of doctors’ knowledge, attitudes and reported practices at regional hospitals in KwaZulu-Natal, South Africa","authors":"Shannon Pillay, Bavani Naicker, Kamlin Ekambaram","doi":"10.1016/j.afjem.2025.100897","DOIUrl":"10.1016/j.afjem.2025.100897","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in both pharmacological and non-pharmacological pain management, children remain vulnerable to oligoanalgesia. Understanding clinical practices and barriers encountered by treating clinicians is essential to inform targeted interventions. This study aimed to examine knowledge, attitudes and reported practices of doctors managing acute paediatric pain in rural regional hospitals in KwaZulu-Natal, South Africa.</div></div><div><h3>Methods</h3><div>An electronic survey was distributed between January and February 2024 to doctors working in the departments of Emergency Medicine, Paediatrics, Surgery, and Orthopaedics at three regional hospitals. The survey included both closed- and open-ended questions addressing analgesic choices, awareness of clinical protocols, and perceived barriers to effective pain management. Descriptive statistics were used to summarise overall trends. Post hoc subgroup analyses were conducted using Chi-square and Fisher’s exact tests. Odds ratios were calculated to describe significant associations.</div></div><div><h3>Results</h3><div>Of 165 clinicians approached, 131 responded (response rate: 80%). Over half (55.7%) reported inadequate training for paediatric pain management, and only 42% were aware of departmental protocols. Paracetamol was the most commonly used analgesic agent. Key barriers included time constraints, limited drug access, and departmental culture. Awareness of departmental paediatric pain protocols was highest (82,9%) in Paediatrics (χ², p<0.001). Paediatric doctors reported significantly greater use of non-pharmacological methods across multiple conditions and procedures. Emergency Medicine respondents more frequently reported opioids for severe abdominal pain (OR=4.24, <em>p</em><0.001, 95% CI 1.96-9.14). Barriers varied by discipline. Paediatrics cited difficulties with pain assessment, while Orthopaedics primarily reported time and staffing constraints.</div></div><div><h3>Conclusion</h3><div>Paediatric pain remains common yet inadequately addressed in Southern Africa. This study identifies insufficient training, poor access to analgesia, and departmental practices as key barriers. Context-specific, cost-effective, multimodal strategies and tailored education are needed to improve care. Sustainable progress requires cultural change, better training, and interdisciplinary collaboration to ensure equitable pain management.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100897"},"PeriodicalIF":1.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-02DOI: 10.1016/j.afjem.2025.100901
Mikiyas G. Teferi, Biruk T. Mengistie, Helina K. Teklehaimanot, Chernet T. Mengistie, Fitsum A. Gemechu, Michael A. Negussie, Tilahun J. Jufara, Getaw W. Hassen
Artificial intelligence (AI) has a supplementary role in clinical toxicology in Africa, addressing key challenges such as delayed diagnoses, limited expertise, and inadequate healthcare infrastructure. This method has the potential to increase diagnostic accuracy, optimize treatment strategies, and advance research on toxic substance exposure and poisoning cases. AI-driven tools, including machine learning algorithms and decision-support systems, enhance the early detection and risk assessment of toxicities. AI-powered predictive models facilitate precision medicine by designing treatment plans for individual patient profiles. Integrating this in telemedicine expands access to toxicology expertise, particularly in resource-limited settings. Additionally, AI accelerates research by analyzing large datasets, identifying trends, and predicting toxicological risks, thus contributing to public health interventions. Despite these advancements, challenges such as data poverty, ethical issues, and restrictive policies hinder its full potential in African healthcare. These gaps can be bridged through policy reforms, capacity-building initiatives, and robust AI frameworks, which will be crucial in maximizing AI benefits for clinical toxicology. This narrative review highlights the emerging applications of AI in Africa, emphasizing the need for collaborative efforts to ensure equitable and effective implementation. However, its adoption is limited by financial constraints, scarce datasets, weak infrastructure, and ethical concerns.
{"title":"Artificial intelligence in clinical toxicology in Africa: Emerging applications and barriers","authors":"Mikiyas G. Teferi, Biruk T. Mengistie, Helina K. Teklehaimanot, Chernet T. Mengistie, Fitsum A. Gemechu, Michael A. Negussie, Tilahun J. Jufara, Getaw W. Hassen","doi":"10.1016/j.afjem.2025.100901","DOIUrl":"10.1016/j.afjem.2025.100901","url":null,"abstract":"<div><div>Artificial intelligence (AI) has a supplementary role in clinical toxicology in Africa, addressing key challenges such as delayed diagnoses, limited expertise, and inadequate healthcare infrastructure. This method has the potential to increase diagnostic accuracy, optimize treatment strategies, and advance research on toxic substance exposure and poisoning cases. AI-driven tools, including machine learning algorithms and decision-support systems, enhance the early detection and risk assessment of toxicities. AI-powered predictive models facilitate precision medicine by designing treatment plans for individual patient profiles. Integrating this in telemedicine expands access to toxicology expertise, particularly in resource-limited settings. Additionally, AI accelerates research by analyzing large datasets, identifying trends, and predicting toxicological risks, thus contributing to public health interventions. Despite these advancements, challenges such as data poverty, ethical issues, and restrictive policies hinder its full potential in African healthcare. These gaps can be bridged through policy reforms, capacity-building initiatives, and robust AI frameworks, which will be crucial in maximizing AI benefits for clinical toxicology. This narrative review highlights the emerging applications of AI in Africa, emphasizing the need for collaborative efforts to ensure equitable and effective implementation. However, its adoption is limited by financial constraints, scarce datasets, weak infrastructure, and ethical concerns.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100901"},"PeriodicalIF":1.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.afjem.2025.100895
Faustin Turamyimana, Jean Paul Dushime, Appolinaire Manirafasha, Deninson Martin Kyle, Doris Lorette Uwamahoro, Francois Regis Twagirumukiza, Pascal Mugemangango, Seraphina Negash, Anna Dobbins
Background: Emergency Department consultation for non-traumatic abdominal pain is one of the common reasons for presentation; accounting for 5.76-20 % of all Emergency Department consultations. Research about non-traumatic abdominal pain is limited in Rwanda and East Africa. This study aims to understand the clinical profile and outcomes of non-traumatic abdominal pain at the largest tertiary hospital in Rwanda.
Methodology: A prospective cohort study of patients presenting with non-traumatic abdominal pain was undertaken.
Results: During the 5-month study, two hundred sixty-one patients were enrolled in the study. The mean age was 39.7 years and male patients accounted for 57.5 % of the cohort. Nearly half of the cohort were triaged as a high priority (11.1 % red, 31.8 % orange), and 42.9 % were hemodynamically unstable at or shortly after presentation. More than half of the patients (57 %) had surgical conditions, including 40.2 % who underwent surgery and 17.6 % who were treated conservatively. The most common diagnoses were intestinal obstruction (25.7 % of all cases) and hollow viscus perforation (18.8 %). Mortality was 11.1 %, and the mean hospital length of stay was 9.1 days. Predicting factors for death outcome (p-value<0.05) were advanced age, altered mental status, jaundice at presentation, peritonitis, known malignancy, and acute kidney injury.
Conclusion: Abdominal pain is a common presenting problem, accounting for approximately 1 in 10 patients presenting to a tertiary care centre in Rwanda, with 2 in 5 patients requiring operative interventions. Identification of potential risk factors for mortality requires a multidisciplinary approach to decrease mortality and morbidity.
{"title":"Acute non-traumatic abdominal pain presenting to emergency unit of a university teaching hospital in Rwanda.","authors":"Faustin Turamyimana, Jean Paul Dushime, Appolinaire Manirafasha, Deninson Martin Kyle, Doris Lorette Uwamahoro, Francois Regis Twagirumukiza, Pascal Mugemangango, Seraphina Negash, Anna Dobbins","doi":"10.1016/j.afjem.2025.100895","DOIUrl":"10.1016/j.afjem.2025.100895","url":null,"abstract":"<p><strong>Background: </strong>Emergency Department consultation for non-traumatic abdominal pain is one of the common reasons for presentation; accounting for 5.76-20 % of all Emergency Department consultations. Research about non-traumatic abdominal pain is limited in Rwanda and East Africa. This study aims to understand the clinical profile and outcomes of non-traumatic abdominal pain at the largest tertiary hospital in Rwanda.</p><p><strong>Methodology: </strong>A prospective cohort study of patients presenting with non-traumatic abdominal pain was undertaken.</p><p><strong>Results: </strong>During the 5-month study, two hundred sixty-one patients were enrolled in the study. The mean age was 39.7 years and male patients accounted for 57.5 % of the cohort. Nearly half of the cohort were triaged as a high priority (11.1 % red, 31.8 % orange), and 42.9 % were hemodynamically unstable at or shortly after presentation. More than half of the patients (57 %) had surgical conditions, including 40.2 % who underwent surgery and 17.6 % who were treated conservatively. The most common diagnoses were intestinal obstruction (25.7 % of all cases) and hollow viscus perforation (18.8 %). Mortality was 11.1 %, and the mean hospital length of stay was 9.1 days. Predicting factors for death outcome (p-value<0.05) were advanced age, altered mental status, jaundice at presentation, peritonitis, known malignancy, and acute kidney injury.</p><p><strong>Conclusion: </strong>Abdominal pain is a common presenting problem, accounting for approximately 1 in 10 patients presenting to a tertiary care centre in Rwanda, with 2 in 5 patients requiring operative interventions. Identification of potential risk factors for mortality requires a multidisciplinary approach to decrease mortality and morbidity.</p>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"100895"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876058","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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