Abstract
BackgroundWhile there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries. We assessed the structure and availability of resources for Emergency and Critical Care in Tanzania in order to identify the priorities for improving care in this neglected specialty.MethodsTen hospitals in four regions of Tanzania were assessed using a structured data collection tool. Quality was evaluated with standards developed from the literature and expert opinion.ResultsImportant deficits were identified in infrastructure, routines and training. Only 30% of the hospitals had an emergency room for adult and paediatric patients. None of the seven district and regional hospitals had a triage area or intensive care unit for adults. Only 40% of the hospitals had formal systems for adult triage and in less than one third were critically ill patients seen by clinicians more than once daily. In 80% of the hospitals there were no staff trained in adult triage or critical care. In contrast, a majority of equipment and drugs necessary for emergency and critical care were available in the hospitals (median 90% and 100% respectively. The referral/private hospitals tended to have a greater overall availability of resources (median 89.7%) than district/regional hospitals (median 70.6).ConclusionsMany of the structures necessary for Emergency and Critical Care are lacking in hospitals in Tanzania. Particular weaknesses are infrastructure, routines and training, whereas the availability of drugs and equipment is generally good. Policies to improve hospital systems for the care of emergency and critically ill patients should be prioritised.
Highlights
While there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries
A structured interview was conducted with the head of the hospital and all areas of the hospital involved in Emergency and Critical Care (EaCC) were visited and the facilities assessed using a data collection tool divided into hospital specialties to ensure that the facilities for all patient groups were observed
Of the ten hospitals included in the study, four were district hospitals, three were regional hospitals, two were national referral hospitals and one was a privately owned mission http://www.biomedcentral.com/1472-6963/13/140
Summary
While there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries. Emergency and Critical Care (EaCC) is one of the weakest parts of health systems in low-income countries [1]. Defined as the care given in hospital to patients with serious reversible disease, EaCC encompasses both the emergency care on arrival plus the care of inpatients when in a critical state. Ninetynine percent of global maternal mortality is in developing countries [7]. Fifty percent of child deaths in hospitals in developing countries occur within 24 hours of arriving at the hospital [9]
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