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Abstract
Background Resource-limited settings are increasingly experiencing a ‘triple burden’ of disease, composed of trauma, non-communicable diseases (NCDs) and known communicable disease patterns. However, the epidemiology of acute and emergency care is not well characterised and this limits efforts to further develop emergency care capacity.
Objective To define the burden of disease by describing the patient population presenting to the Accident and Emergency Department (A&E) at Kenyatta National Hospital (KNH) in Kenya.
Methods We completed a prospective descriptive assessment of patients in KNH’s A&E obtained via systematic sampling over 3 months. Research assistants collected data directly from patients and their charts. Chief complaint and diagnosis codes were grouped for analysis. Patient demographic characteristics were described using the mean and SD for age and n and percentages for categorical variables. International Classification of Disease 10 codes were categorised by 2013 Global Burden of Disease Study methods.
Results Data were collected prospectively on 402 patients with an average age of 36 years (SD 19), and of whom, 50% were female. Patients were most likely to arrive by taxi or bus (39%), walking (28%) or ambulance (17%). Thirty-five per cent of patients were diagnosed with NCDs, 24% with injuries and 16% with communicable diseases, maternal and neonatal conditions. Overall, head injury was the single most common final diagnosis and occurred in 32 (8%) patients. The most common patient-reported mechanism for head injury was road traffic accident (39%).
Conclusion This study estimates the characteristics of the A&E population at a tertiary centre in Kenya and highlights the triple burden of disease. Our findings emphasise the need for further development of emergency care resources and training to better address patient needs in resource-limited settings, such as KNH.
- accident & emergency medicine
- epidemiology
- international health services
- Trauma Management
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors JM was responsible for the conception of idea for study design, draft of protocol, data collection, analysis and manuscript initiation, reading and approval of final manuscript. KE prepared the RedCap Database. KH was responsible for the statistical analysis and key manuscript formatting. AW was instrumental in the development of the final protocol. KE, AW, AM and IM assisted with data collection. KMH, KE, AW, AM, VM, SD and IBKM were responsible for the analysis and revisions of study design and protocol, analysis and critical revisions of manuscript. All authors had the opportunity to read and approve the final manuscript.
Funding Research funding was provided by the Global Health and Leadership Fellowship at the University of North Carolina and the International Emergency Medicine Fellowship at Hennepin County Medical Center (via the Hennepin Health Foundation).
Competing interests None declared.
Patient consent Obtained.
Ethics approval University of North Carolina Institutional Review Board and the University of Nairobi/Kenyatta National Hospital Ethics Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The database is conjointly owned between the individual co-investigators and their respective departments, including the University of Nairobi and the Kenyatta National Hospital Accident and Emergency Department. The ethical approval for this study obliges us to follow our data sharing agreement (available for review) and to protect the privacy of participants. According to our agreement (filed through the UofN/KNH ERC in 2014-2015), requests for access to this database for data analysis from investigators or institutions outside of the owners will be considered, pending stipulations of Data Use Agreement are observed and that all owners are made aware. Readers can apply for access and permission to this database by contacting the project coordinator at justin_myers@med.unc.edu or through contact with any of the co-investigators.