Delays in arrival and treatment in emergency departments: Women, children and non-trauma consultations the most at risk in humanitarian settings

Abstract

Introduction Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings. Methodology This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays. Results We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2–1.3), children <5 (OR 1.4, 95% CI 1.4–1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6–35.3) and non-trauma cases (OR 4.7, 95% CI 4.4–4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0–1.1), children <5 (OR 2.0, 95% CI 1.9–2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9–15.4) and non-trauma cases (OR 1.6, 95% CI 1.5–1.7). Conclusions Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.

Standing at the edge of mortality; Five-year audit of an emergency department of a tertiary care hospital in a low resource setup

“… 9 This delayed presentation may be compounded by low health literacy, lack of pre hospital care, belief in traditional healers and quality medical facilities inaccessible to the less privileged. 13 , 21 Over half the mortalities in low-resource settings may be addressed by improved emergency care systems. 22 Our study has identified that encouraging timely presentation to healthcare, availability of pre hospital care and swift transfer to tertiary care may mitigate some deaths.…”

Gendered implications of the COVID-19 pandemic for policies and programmes in humanitarian settings

“…5 This again increases the likelihood that they will be exposed to communicable diseases. In addition, social norms prevalent in many humanitarian settings dictate that women and girls are the last to receive medical attention when they become ill. 6 These norms could prevent women and girls-particularly those who are already stigmatised, such as IDPs and refugees, members of certain ethnic or racial groups or those of different sexual orientationsfrom accessing testing and timely treatment for COVID-19. Furthermore, testing may not be available for some displaced populations, as illustrated in Bangladesh, where testing facilities are limited to the capital, Dhaka, which is 400 km away from the world's largest refugee camp in Cox's Bazar.…”

When Land Is Under Pressure Health Is Under Stress

“… Source: [ 26 , 29 , 30 , 33 , 36 , 47 , 49 , 59 , 60 , 61 , 62 , 131 , 136 , 137 ]. Note: each pathway can have multiple health impacts (not shown).…”

“… Source based on [ 4 , 13 , 14 , 16 , 29 , 30 , 35 , 47 , 48 , 50 , 52 , 54 , 137 , 139 , 152 , 157 , 159 , 160 , 161 ]. …”

“…These include poor women, indigenous communities, children, elderly persons, people living in rural, marginal or fragile environments, on land that is particularly vulnerable to degradation, as well as those with a low-income or living in poor areas [ 25 , 26 , 27 , 28 ]. This also applies to those without easy access to health care facilities and persons with pre-existing health conditions [ 26 , 29 , 30 ].…”