Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone

Clark, Matthew; Spry, Emily; Daoh, Kisito S.; Baion, David; Skordis‐Worrall, Jolene

doi:10.1371/journal.pone.0041458

Cited by 41 publications

(34 citation statements)

References 14 publications

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“…Moreover, the contribution of proportion triaged to the effect of the interventions with regard to deaths is more than 50% which highlights the importance of ETAT of patients to reduce mortality as has been noted previously [23,24].…”

Section: Discussionsupporting

confidence: 52%

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

et al. 2016

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SUMMARYWe present an age-structured mathematical model of malaria and pneumonia to study the effect of two capacity-building interventions: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). IMID leads to a reduction in malaria prevalence by more than 2·4% across the [0,5), [5,14) and [14,50) age groups. IMID + OSS reduces it by more than 16·0% across all age groups. IMID decreases pneumonia prevalence by more than 3·0% across all age groups while IMID + OSS decreases it by more than 1·0% across all age groups. The number of malaria and pneumonia deaths is reduced by 7·8% by IMID across all age groups and IMID + OSS decreases this number by 30·5% across all age groups, which translates to saving a life of a child per month. Prevalence of malaria-pneumonia for the [0,5) age group is 0·52% at baseline, and IMID and IMID + OSS reduce it by 6·6% and 23·6%, respectively. There is no change in incidence of malaria or pneumonia disease episodes. The results also indicate that triaging of children contributes more than 50% to the effect of the interventions in reduction of deaths and a range of 14-91% in reduction of disease cases.

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Section: Discussionsupporting

confidence: 52%

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

et al. 2016

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“…This might reflect that the overall disease severity of hospitalised patients was higher as a result of improved triage, but also of a rise in hospital admission fees in 2016. These data stand in contrast to other studies, were in-hospital mortality rate decreased after implementation of a triaging system and emergency care in urban hospitals in sub-Saharan Africa [5][6][7][8]. Data about mortality in our study were retrospectively retrieved from register books from the wards, which might not have been completed properly.…”

Section: Discussionmentioning

confidence: 85%

“…Information on diagnoses made in emergency departments of hospitals in sub-Saharan Africa is scarce, and there are no reports on hospital mortality rates before and after implementing an emergency department in a rural hospital. However, the implementation of a triaging system and training of clinical staff in emergency care has been shown to be associated with a decrease of inhospital mortality rates in urban hospitals in Malawi, Sierra Leone and Tanzania [5][6][7][8]. During 1 year, we prospectively collated diagnoses of all patients presenting to the newly established emergency department in the St Francis Referral Hospital in Ifakara, Tanzania, and recorded inhospital mortality rates before and after the implementation of the emergency department.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Although these guidelines do not include mechanical ventilation or other ICU technologies, they do address triage and emergency treatments. Implementation of pediatric triage has been associated with improved outcomes in Sierra Leone [104], and a single center, pilot study in Haiti evaluating the Integrated Manual for Adult and Adolescent Illness (IMAI) protocol for severe sepsis demonstrated increased sepsis recognition, greater volume of fluid resuscitation, and increased frequency of vital signs monitoring [105].…”

Section: Clinical Guidelinesmentioning

confidence: 99%

Global Critical Care: Moving Forward in Resource-Limited Settings

Dı́az

Riviello

Papali

et al. 2019

Annals of Global Health

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IntroductionCritical care is an important component of health care systems around the world (Figure 1). Caring for critically ill patients in resource-rich settings typically involves treatment in intensive care units (ICUs) staffed with highly specialized health care professionals, systematic monitoring and use of high-cost technology [1]. Unfortunately, these components are not always available in resource-limited settings [2, 3], where the burden of disease is greater [4], outcomes are poorer [5, 6], and local characteristics require context-specific approaches to the organization of critical care services.Critical care delivery, education, and research require a global perspective based on epidemiologic considerations. The burden of critical illness in resource-limited settings is not well described, but the best available estimates suggest that it may be greater than in resource-rich settings [7, 8] due to deficiencies in access to health care, emergency triage, and lack of early recognition [9][10][11]. Mortality for adults with sepsis [5, 12, 13] and acute respiratory distress syndrome (ARDS) [14][15][16] in resource-limited settings is higher than in resource-rich settings, and decedents are usually young (mean age 35 years vs. 61 years in United States) [12,17], which contributes to a greater negative downstream social and economic impact. Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. Ethically, health care professionals, trainees, professional societies, non-governmental organizations (NGOs), and international organizations from resource-rich settings have the capacity of deploying resources to improve outcomes for critically ill patients in resource-limited settings [11,23,24]. Assistance can include financial help, knowledge exchange in the form of research and educational partnerships, and capacity building in operations and implementation science. From a practical point of view, supporting resource-limited settings is also important given that inter-related economies, Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and in...

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Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone

Cited by 41 publications

References 14 publications

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

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

Global Critical Care: Moving Forward in Resource-Limited Settings

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