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

Abstract

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.

Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

“…In a study from Ifakara, Tanzania, infectious disease and trauma were noted as primary diagnoses. However, similar to cardiovascular rates seen in the present data, hypertensive emergency was noted as the leading diagnosis in those > 50 years of age [18]. Disease-specific studies in Tanzania have noted similarly high rates of cardiovascular and neurologic pathology [19] as well as renal disease [20] and gastrointestinal pathology [21] as seen in this study.…”

Emergency Medicine Matters: Epidemiology of Medical Pathology and Changes in Patient Outcomes after Implementation of a Post-graduate Training Program at a Tertiary Teaching Hospital in Kigali, Rwanda

“…However, similar to cardiovascular rates seen in the present data, hypertensive emergency was noted as the leading diagnosis in those > 50 years of age. 16 Disease-speci c studies in Tanzania have noted similarly high rates of cardiovascular and neurologic pathology 17 as well as renal disease 18 and gastrointestinal pathology 19 as seen in this study. Thus, this study helps to establish a foundation of the epidemiology of medical pathology amongst adult patients in LMICs and more speci cally, Africa which will facilitate better understanding of care and resource needs in those settings.…”

Ultrasonographic findings in patients with abdominal symptoms or trauma presenting to an emergency room in rural Tanzania

“…This prospective observational single centre study was performed at the ED of the SFRH, which serves as a referral centre for a rural population of more than one million people living in the Kilombero valley, in the Southwest of Tanzania [ 9 ]. The SFRH has 360 beds and specialized services in internal medicine, heart- and lung diseases, pediatrics, surgery, obstetrics, neonatology and gynaecology, ophthalmology, HIV and tuberculosis care, and emergency services.…”

“…In a previous study done at the Saint Francis Referral Hospital (SFRH) in Ifakara, rural South-western Tanzania, 10% of the patients attending the emergency department (ED) suffered from trauma and 6% from abdominal disorders [ 9 ]. Point-of-care ultrasound (POCUS) has proven to be a reliable, fast, non-invasive, and cost-effective tool to support diagnosis and improve management of patients suffering from trauma and acute abdominal symptoms [ 10 – 16 ].…”