RT Journal Article
SR Electronic
T1 Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e006132
DO 10.1136/bmjopen-2014-006132
VO 4
IS 9
A1 Thomas F Burke
A1 Rosemary Hines
A1 Roy Ahn
A1 Michelle Walters
A1 David Young
A1 Rachel Eleanor Anderson
A1 Sabrina M Tom
A1 Rachel Clark
A1 Walter Obita
A1 Brett D Nelson
YR 2014
UL http://bmjopen.bmj.com/content/4/9/e006132.abstract
AB Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting.Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding.Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines.Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings.