Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Abstract

Low-and middle-income countries (LMICs) have a large percentage of global mortality and morbidity rates from non-communicable diseases, including trauma. The establishment and development of emergency care systems is crucial for addressing this problem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICs is essential for proper design and operation of ECS (emergency care services) reinforcement programs. Myanmar has particular challenges with road access for providing timely emergency medical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar, we used the Emergency Care Assessment Tool (ECAT), which features newly developed tools for assessing sentinel conditions and signal functions (key interventions to address morbidity and mortality) in emergency care facilities. Methods: ECAT is composed of six emergent sentinel conditions and corresponding signal functions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed survey sheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarify ambiguous answers. Results:We categorized the nine participating institutions according to predefined criteria: four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basic hospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of the intermediate hospitals showed weakness in trauma care, as well as critical care such as shock management. Only half had a separate triage area for patients. In contrast, all signal functions and resources listed in ECAT were available in the advanced-level hospital. Conclusion:Basic-level facilities in Myanmar were shown to be suboptimal in trauma management, with critical care also inadequate in intermediate facilities. To reinforce signal functions in Myanmar health facilities, stakeholders should consider expanding critical functions in selected lower-level health facilities. A larger scale survey would provide more comprehensive data to improve emergency care in Myanmar. [

Emergency Services Capacity of a Rural Community in Guatemala

“…In terms of positive findings, we found high availability of basic PPE in all surveyed facilities, similar to conditions in Myanmar 23 and Ghana. 24 It should be noted, however, that our study was conducted before the coronavirus 2019 pandemic and may not reflect global changes and shortages of PPE.…”

“…10 A similar study in urban and rural Myanmar found universal availability of oxygen and oral antibiotics at all facility levels, 23 although in that study and all others, the availability of epinephrine was not assessed in clinics. 23,24,27,28,33 Like the limitations in medication and oxygen, we also found a significant deficiency in pediatric equipment availability across all facilities. Previous studies have not conducted comprehensive pediatric emergency assessments, and this is the first report to do so.…”

“…This is compared to 60% medication availability in El Salvador. 10 A similar study in urban and rural Myanmar found universal availability of oxygen and oral antibiotics at all facility levels, 23 although in that study and all others, the availability of epinephrine was not assessed in clinics. 23 , 24 , 27 , 28 , 33 …”

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“…This tool has been used previously in several LMICs to evaluate emergency care provision in facilities. [11][12][13][14] It is divided into four sections:…”