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Original article

Vol. 149 No. 0506 (2019)

Diagnoses made in an Emergency Department in rural sub-Saharan Africa

  • Elisante Mchomvu
  • Geoffrey Mbunda
  • Noemi Simon
  • Faraji Kitila
  • Yvan Temba
  • Isaiac Msumba
  • Jabir Namamba
  • Said Kilindimo
  • Hellen Mgubike
  • Winfrid Gingo
  • Christoph Hatz
  • Daniel H. Paris
  • Maja Weisser
  • Martin Rohacek
DOI
https://doi.org/10.4414/smw.2019.20018
Cite this as:
Swiss Med Wkly. 2019;149:w20018
Published
04.02.2019

Summary

BACKGROUND

Information on diagnoses made in emergency departments situated in rural sub-Saharan Africa is scarce. The aim was: to evaluate the frequency of different diagnoses made in a new emergency department to define relevant healthcare requirements; and to find out if in-hospital mortality rates would decrease after the implementation of the emergency department.

METHODS

In this observational study, we prospectively collated diagnoses of all patients presenting to the emergency department of the St Francis Referral Hospital in Ifakara, Tanzania during 1 year. In addition, we compared in-hospital mortality rates before and after the implementation of the emergency department.

RESULTS

From July 2016 through to June 2017, a total of 35,903 patients were included. The median age was 33.6 years (range 1 day to 100 years), 57% were female, 25% were children <5 years, 4% were pregnant and 9% were hospitalised. The most common diagnoses were respiratory tract infection (12.6%), urinary tract infection (11.4%), trauma (9.8%), undifferentiated febrile illness (5.4%), and malaria (5.2%). The most common clinical diagnoses per age group were: lower respiratory tract infection (16.1%) in children <5 years old; trauma (21.6%) in 5- to 17-year-olds; urinary tract infection (13.5%) in 18- to 50-year-olds; and hypertensive emergency (12.4%) in >50-year-olds. Respiratory tract infections peaked in April during the rainy season, whereas malaria peaked 3 months after the rainy season. In-hospital mortality rates did not decrease during the study period (5.6% in 2015 vs 7.6% in 2017).

CONCLUSIONS

The majority of diagnosed disorders were of infectious or traumatic origin. The majority of febrile illnesses were poorly defined because of the lack of diagnostic methods. Trauma systems and inexpensive accurate diagnostic methods for febrile illnesses are needed in rural sub-Saharan Africa.

References

  1. Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626–31.
  2. Ouma PO, Maina J, Thuranira PN, Macharia PM, Alegana VA, English M, et al. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Glob Health. 2018;6(3):e342–50. doi:.https://doi.org/10.1016/S2214-109X(17)30488-6
  3. Obermeyer Z, Abujaber S, Makar M, Stoll S, Kayden SR, Wallis LA, et al.; Acute Care Development Consortium. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ. 2015;93(8):577–586G. doi:.https://doi.org/10.2471/BLT.14.148338
  4. Baker T, Lugazia E, Eriksen J, Mwafongo V, Irestedt L, Konrad D. Emergency and critical care services in Tanzania: a survey of ten hospitals. BMC Health Serv Res. 2013;13(1):140. doi:.https://doi.org/10.1186/1472-6963-13-140
  5. Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ. 2006;84(4):314–9. doi:.https://doi.org/10.2471/BLT.04.019505
  6. Clark M, Spry E, Daoh K, Baion D, Skordis-Worrall J. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone. PLoS One. 2012;7(9):e41458. doi:.https://doi.org/10.1371/journal.pone.0041458
  7. Robison JA, Ahmad ZP, Nosek CA, Durand C, Namathanga A, Milazi R, et al. Decreased pediatric hospital mortality after an intervention to improve emergency care in Lilongwe, Malawi. Pediatrics. 2012;130(3):e676–82. doi:.https://doi.org/10.1542/peds.2012-0026
  8. Sawe HR, Mfinanga JA, Mwafongo V, Reynolds TA, Runyon MS. Trends in mortality associated with opening of a full-capacity public emergency department at the main tertiary-level hospital in Tanzania. Int J Emerg Med. 2015;8(1):24. doi:.https://doi.org/10.1186/s12245-015-0073-4
  9. Twomey M, Wallis LA, Thompson ML, Myers JE. The South African Triage Scale (adult version) provides reliable acuity ratings. Int Emerg Nurs. 2012;20(3):142–50. doi:.https://doi.org/10.1016/j.ienj.2011.08.002
  10. Sunyoto T, Van den Bergh R, Valles P, Gutierrez R, Ayada L, Zachariah R, et al. Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study. BMC Health Serv Res. 2014;14(1):531. doi:.https://doi.org/10.1186/s12913-014-0531-3
  11. Dalwai M, Valles P, Twomey M, Nzomukunda Y, Jonjo P, Sasikumar M, et al. Is the South African Triage Scale valid for use in Afghanistan, Haiti and Sierra Leone? BMJ Glob Health. 2017;2(2):e000160. doi:.https://doi.org/10.1136/bmjgh-2016-000160
  12. Shek LP, Lee BW. Epidemiology and seasonality of respiratory tract virus infections in the tropics. Paediatr Respir Rev. 2003;4(2):105–11. doi:.https://doi.org/10.1016/S1526-0542(03)00024-1
  13. Ho NT, Thompson C, Nhan LNT, Van HMT, Dung NT, Tran My P, et al. Retrospective analysis assessing the spatial and temporal distribution of paediatric acute respiratory tract infections in Ho Chi Minh City, Vietnam. BMJ Open. 2018;8(1):e016349. doi:.https://doi.org/10.1136/bmjopen-2017-016349
  14. D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, et al. Beyond malaria--causes of fever in outpatient Tanzanian children. N Engl J Med. 2014;370(9):809–17. doi:.https://doi.org/10.1056/NEJMoa1214482
  15. Ouédraogo S, Traoré B, Nene Bi ZA, Yonli FT, Kima D, Bonané P, et al. Viral etiology of respiratory tract infections in children at the pediatric hospital in Ouagadougou (Burkina Faso). PLoS One. 2014;9(10):e110435. doi:.https://doi.org/10.1371/journal.pone.0110435
  16. Goto T, Yoshida K, Tsugawa Y, Camargo CA, Jr, Hasegawa K. Infectious Disease-Related Emergency Department Visits of Elderly Adults in the United States, 2011-2012. J Am Geriatr Soc. 2016;64(1):31–6. doi:.https://doi.org/10.1111/jgs.13836
  17. Musa-Aisien AS, Ibadin OM, Ukoh G, Akpede GO. Prevalence and antimicrobial sensitivity pattern in urinary tract infection in febrile under-5s at a children’s emergency unit in Nigeria. Ann Trop Paediatr. 2003;23(1):39–45. doi:.https://doi.org/10.1179/000349803125002850
  18. Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev. 2005;18(2):417–22. doi:.https://doi.org/10.1128/CMR.18.2.417-422.2005
  19. Gordon LB, Waxman MJ, Ragsdale L, Mermel LA. Overtreatment of presumed urinary tract infection in older women presenting to the emergency department. J Am Geriatr Soc. 2013;61(5):788–92. doi:.https://doi.org/10.1111/jgs.12203
  20. Abba K, Deeks JJ, Olliaro P, Naing CM, Jackson SM, Takwoingi Y, et al. Rapid diagnostic tests for diagnosing uncomplicated P. falciparum malaria in endemic countries. Cochrane Database Syst Rev. 2011;(7):CD008122. doi:.https://doi.org/10.1002/14651858.CD008122.pub2
  21. WHO. World Malaria Report 2017. 2017.
  22. Kipruto EK, Ochieng AO, Anyona DN, Mbalanya M, Mutua EN, Onguru D, et al. Effect of climatic variability on malaria trends in Baringo County, Kenya. Malar J. 2017;16(1):220. doi:.https://doi.org/10.1186/s12936-017-1848-2
  23. Reiner RC, Jr, Geary M, Atkinson PM, Smith DL, Gething PW. Seasonality of Plasmodium falciparum transmission: a systematic review. Malar J. 2015;14(1):343. doi:.https://doi.org/10.1186/s12936-015-0849-2
  24. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, et al. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya. PLoS One. 2011;6(1):e16085. doi:.https://doi.org/10.1371/journal.pone.0016085
  25. Crump JA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, Galloway RL, et al. Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis. 2013;7(7):e2324. doi:.https://doi.org/10.1371/journal.pntd.0002324
  26. Blacksell SD, Kantipong P, Watthanaworawit W, Turner C, Tanganuchitcharnchai A, Jintawon S, et al. Underrecognized arthropod-borne and zoonotic pathogens in northern and northwestern Thailand: serological evidence and opportunities for awareness. Vector Borne Zoonotic Dis. 2015;15(5):285–90. doi:.https://doi.org/10.1089/vbz.2015.1776
  27. Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: A systematic review. PLoS Negl Trop Dis. 2017;11(9):e0005838. doi:.https://doi.org/10.1371/journal.pntd.0005838
  28. García-Moreno C, Zimmerman C, Morris-Gehring A, Heise L, Amin A, Abrahams N, et al. Addressing violence against women: a call to action. Lancet. 2015;385(9978):1685–95. doi:.https://doi.org/10.1016/S0140-6736(14)61830-4
  29. Barr AL, Knight L, Franҫa-Junior I, Allen E, Naker D, Devries KM. Methods to increase reporting of childhood sexual abuse in surveys: the sensitivity and specificity of face-to-face interviews versus a sealed envelope method in Ugandan primary school children. BMC Int Health Hum Rights. 2017;17(1):4. doi:.https://doi.org/10.1186/s12914-016-0110-2
  30. Sawe HR, Mfinanga JA, Mbaya KR, Koka PM, Kilindimo SS, Runyon MS, et al. Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals. BMC Emerg Med. 2017;17(1):30. doi:.https://doi.org/10.1186/s12873-017-0141-6
  31. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016;22(1):3–18. doi:.https://doi.org/10.1136/injuryprev-2015-041616
  32. WHO. Injuries and violence: The facts 2014. appswhoint/iris/bitstream/10665/149798/1/9789241508018_engpdf. 2014.
  33. https://www.scribd.com/document/367004515/Advanced-Trauma-Life-Support-ATLS-Student-Course-Manual-2018 ACoSATLSAScmte.
  34. Abu-Zidan FM. Advanced trauma life support training: How useful it is? World J Crit Care Med. 2016;5(1):12–6. doi:.https://doi.org/10.5492/wjccm.v5.i1.12
  35. Moore L, Champion H, Tardif PA, Kuimi BL, O’Reilly G, Leppaniemi A, et al.; International Injury Care Improvement Initiative. Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis. World J Surg. 2018;42(5):1327–39. doi:.https://doi.org/10.1007/s00268-017-4292-0
  36. Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma. 2006;60(2):371–8, discussion 378. doi:.https://doi.org/10.1097/01.ta.0000197916.99629.eb
  37. Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, Judson R, et al. Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg. 2012;255(6):1009–15. doi:.https://doi.org/10.1097/SLA.0b013e31824c4b91
  38. WHO. Global Health Estimates 2015: Death by Cause A, Sex, by Country and by Region, 2000-2015. Geneva, World Health Organization. 2016.
  39. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension. 2015;65(2):291–8. doi:.https://doi.org/10.1161/HYPERTENSIONAHA.114.04394
  40. Price AJ, Crampin AC, Amberbir A, Kayuni-Chihana N, Musicha C, Tafatatha T, et al. Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi. Lancet Diabetes Endocrinol. 2018;6(3):208–22. doi:.https://doi.org/10.1016/S2213-8587(17)30432-1
  41. Ramaiya AGE. HIV and NDC: The burden of chronic disease in rural Tanzania. available at: https://drive.google.com/file/d/0B7y5ETfTjl4xREwyQUg0SkgzR0k/edit. Spotlight 2014(19).
  42. Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet. 2010;376(9747):1186–93. doi:.https://doi.org/10.1016/S0140-6736(10)61152-X
  43. Disease GBD, Injury I, Prevalence C ; GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59. doi:.https://doi.org/10.1016/S0140-6736(17)32154-2
  44. Jarman MP, Castillo RC, Carlini AR, Kodadek LM, Haider AH. Rural risk: Geographic disparities in trauma mortality. Surgery. 2016;160(6):1551–9. doi:.https://doi.org/10.1016/j.surg.2016.06.020
  45. Jarman MP, Curriero FC, Haut ER, Pollack Porter K, Castillo RC. Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality. JAMA Surg. 2018.
  46. Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health. 2015;3(7):e387–95. doi:.https://doi.org/10.1016/S2214-109X(15)00048-0
  47. Pruinelli L, Westra BL, Yadav P, Hoff A, Steinbach M, Kumar V, et al. Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock. Crit Care Med. 2018;46(4):500–5. doi:.https://doi.org/10.1097/CCM.0000000000002949

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