Journal Article > ResearchFull Text
BMC Health Serv Res. 2014 November 6; Volume 14 (Issue 1); DOI:10.1186/s12913-014-0531-3
Sunyoto T, Van der Bergh R, Valles P, Gutierrez RO, Ayada L, et al.
BMC Health Serv Res. 2014 November 6; Volume 14 (Issue 1); DOI:10.1186/s12913-014-0531-3
BackgroundIn resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.MethodsA cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (¿high acuity¿ proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).ResultsIn 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.ConclusionThis is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2011 October 1; Volume 15 (Issue 10); 1367-1372.; DOI:10.5588/ijtld.10.0751
Tayler-Smith K, Khogali MA, Keiluhu K, Jemmy J-P, Ayada L, et al.
Int J Tuberc Lung Dis. 2011 October 1; Volume 15 (Issue 10); 1367-1372.; DOI:10.5588/ijtld.10.0751
SETTING
In Cherrati District, Somali Regional State (SRS), Ethiopia, despite a high burden of tuberculosis (TB), TB control activities are virtually absent. The majority of the population is pastoralist with a mobile lifestyle. TB care and treatment were offered using a 'TB village' approach that included traditional style residential care, community empowerment and awareness raising, provision of essential social amenities and essential food and non-food items.
OBJECTIVE
To describe 1) key aspects of the implementation of the TB village approach, 2) TB treatment outcomes and 3) the lessons learnt during implementation.
DESIGN
Descriptive study.
RESULTS
A total of 297 patients entered the TB village between September 2006 and October 2008; 271 (91%) patients were treated successfully, nine (3%) defaulted and 13 (4%) died.
CONCLUSIONS
For pastoralist populations, a TB village approach may be effective for improving access to TB care, ensuring proper adherence to treatment and achieving good overall TB outcomes. The successes and challenges of this approach are discussed
In Cherrati District, Somali Regional State (SRS), Ethiopia, despite a high burden of tuberculosis (TB), TB control activities are virtually absent. The majority of the population is pastoralist with a mobile lifestyle. TB care and treatment were offered using a 'TB village' approach that included traditional style residential care, community empowerment and awareness raising, provision of essential social amenities and essential food and non-food items.
OBJECTIVE
To describe 1) key aspects of the implementation of the TB village approach, 2) TB treatment outcomes and 3) the lessons learnt during implementation.
DESIGN
Descriptive study.
RESULTS
A total of 297 patients entered the TB village between September 2006 and October 2008; 271 (91%) patients were treated successfully, nine (3%) defaulted and 13 (4%) died.
CONCLUSIONS
For pastoralist populations, a TB village approach may be effective for improving access to TB care, ensuring proper adherence to treatment and achieving good overall TB outcomes. The successes and challenges of this approach are discussed
Journal Article > Short ReportAbstract
Int Health. 2014 January 14; Volume 6 (Issue 1); DOI:10.1093/inthealth/iht035
Maalim A, Zachariah R, Khogali MA, van Griensven J, Van der Bergh R, et al.
Int Health. 2014 January 14; Volume 6 (Issue 1); DOI:10.1093/inthealth/iht035
Journal Article > Short ReportFull Text
Public Health Action. 2013 June 21; Volume 3 (Issue 2); 125-127.; DOI:10.5588/pha.12.0104
Ngoy BB, Zachariah R, Hinderaker SG, Khogali MA, Manzi M, et al.
Public Health Action. 2013 June 21; Volume 3 (Issue 2); 125-127.; DOI:10.5588/pha.12.0104
SETTING
A district hospital in conflict-torn Somalia.
OBJECTIVE
To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care.
DESIGN
Cross-sectional study.
RESULTS
Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded.
CONCLUSION
Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.
A district hospital in conflict-torn Somalia.
OBJECTIVE
To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care.
DESIGN
Cross-sectional study.
RESULTS
Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded.
CONCLUSION
Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.
Journal Article > Short ReportFull Text
Trop Med Int Health. 2012 July 29; Volume 7 (Issue 9); 1156-1162.; DOI:10.1111/j.1365-3156.2012.03047
Zachariah R, Benvenuti B, Ayada L, Manzi M, Maalim A, et al.
Trop Med Int Health. 2012 July 29; Volume 7 (Issue 9); 1156-1162.; DOI:10.1111/j.1365-3156.2012.03047
OBJECTIVES
In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians.
METHODS
A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians.
RESULTS
Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value.
CONCLUSION
The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.
In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians.
METHODS
A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians.
RESULTS
Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value.
CONCLUSION
The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.