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What resources are used in emergency departments in rural sub-Saharan Africa? A retrospective analysis of patient care in a district-level hospital in Uganda
  1. Cindy Carol Bitter1,2,
  2. Brian Rice2,3,
  3. Usha Periyanayagam2,4,
  4. Bradley Dreifuss2,5,6,
  5. Heather Hammerstedt2,7,
  6. Sara W Nelson2,8,
  7. Mark Bisanzo2,9,
  8. Samuel Maling10,
  9. Stacey Chamberlain2,11
  1. 1 Division of Emergency Medicine, Department of Surgery, Saint Louis University, St. Louis, Missouri, USA
  2. 2 Global Emergency Care
  3. 3 Department of Emergency Medicine, New York University Langone Medical Center, New York City, New York, USA
  4. 4 Harvard Humanitarian Initiative, Harvard University, Boston, Massachusetts, USA
  5. 5 Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
  6. 6 Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
  7. 7 Department of Emergency Medicine, CEPA-Idaho, Boise, Idaho, USA
  8. 8 Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
  9. 9 Division of Emergency Medicine, Department of Surgery, University of Vermont, Burlington, Vermont, USA
  10. 10 College of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  11. 11 Department of Emergency Medicine and the Center for Global Health, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Dr Mark Bisanzo; mbisanzo{at}


Objectives To determine the most commonly used resources (provider procedural skills, medications, laboratory studies and imaging) needed to care for patients.

Setting A single emergency department (ED) of a district-level hospital in rural Uganda.

Participants 26 710 patient visits.

Results Procedures were performed for 65.6% of patients, predominantly intravenous cannulation, wound care, bladder catheterisation and orthopaedic procedures. Medications were administered to 87.6% of patients, most often pain medications, antibiotics, intravenous fluids, antimalarials, nutritional supplements and vaccinations. Laboratory testing was used for 85% of patients, predominantly malaria smears, rapid glucose testing, HIV assays, blood counts, urinalyses and blood type. Radiology testing was performed for 17.3% of patients, including X-rays, point-of-care ultrasound and formal ultrasound.

Conclusion This study describes the skills and resources needed to care for a large prospective cohort of patients seen in a district hospital ED in rural sub-Saharan Africa. It demonstrates that the vast majority of patients were treated with a small formulary of critical medications and limited access to laboratories and imaging, but providers require a broad set of decision-making and procedural skills.

  • procedural skills
  • medication formulary
  • radiology services
  • point-of-care ultrasound
  • sub-saharan africa
  • acute care

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  • Contributors MB, SC, UP, HH, BD and SWN designed the database and conceived the study. CCB, BR and UP performed data cleaning, statistical analysis and submission of this work. CCB, SC and UP drafted the manuscript and all authors revised it. SM provided programme support for ECP curriculum development and contributed to study design. All authors take responsibility for the paper as a whole.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Mbarara University of Science and Technology Institutional Review Board, the Uganda National Council for Science and Technology and University of Massachusetts Institutional Review Board (reference number HS 1405). Local approval was obtained from the medical superintendent of the hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Files will not be available for sharing.

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