Paediatric Emergency Triage, Assessment and Treatment (ETAT) – preparedness for implementation at primary care facilities in Malawi

Carina King,Albert Dube,Beatiwel Zadutsa,Lumbani Banda,Josephine Langton,Nicola Desmond,Norman Lufesi,Charles Makwenda,Helena Hildenwall

doi:10.1080/16549716.2021.1989807

Abstract

ABSTRACT Background The majority of deaths amongst children under 5 years are still due to preventable infectious causes. Emergency care has been identified as a key health system weakness, and referrals are often challenging. Objective We aimed to establish how prepared frontline facilities in Malawi are to implement WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, to support policy and planning decisions. Methods We conducted a concurrent mixed-methods study, including facility audit; healthcare provider survey; focus group discussions (FGD) and semi-structured interviews with facility staff. The study was conducted in two districts in Malawi, Zomba and Mchinji, between January and May 2019. We included all frontline facilities, including dispensaries, primary health centres, rural and community hospitals. Quantitative data were described using proportions, means and linear regression. Qualitative data was analysed using a framework approach. Data were analysed separately and then triangulated into common themes. Results Forty-seven facilities and 531 healthcare providers were included in the audit and survey; 6 FGDs and 5 interviews were completed. Four common themes emerged: (1) current emergency case management; (2) referral practices; (3) trained staff capacity; (4) opportunities and barriers for ETAT. Triage was conducted in most facilities with various methods described, and 53% reporting all staff are responsible. Referrals were common, but challenging due to issues in transportation. Twelve percent of survey respondents had ETAT training, with clinical officers (41%) reporting this more frequently than other cadres. Training was associated with increased knowledge, independent of cadre. The main barriers to ETAT implementation were the lack of resources, but opportunities to improve quality of care were reported. Conclusions Malawian frontline facilities are already providing a level of emergency paediatric care, but issues in training, drug supplies and equipment were present. To effectively scale-up ETAT, policies need to include supply chain management, maintenance and strengthening referral communication.

Highlights

The majority of deaths amongst children under 5 years are still due to preventable infectious causes
Healthcare is provided free of charge in government facilities, and small user fees are charged by facilities run by the Christian Health Association of Malawi (CHAM)
We present quantitative and qualitative data together under the following themes (Figure 1): current emergency case management, referral practices, trained staff capacity and opportunities and barriers for Emergency Triage Assessment and Treatment (ETAT)

Summary

Introduction

The majority of deaths amongst children under 5 years are still due to preventable infectious causes. National and global initiatives to improve access to basic care through standardised programmes such as the World Health Organisation’s (WHO) Integrated Management of Childhood Illness (IMCI) and inte grated Community Case Management (iCCM) [2,3] have contributed to reductions in paediatric mortality [4]. Both IMCI and iCCM were designed for primary care settings to promote access and early initiation of first-line treatment or referral of severe cases to inpa tient facilities.

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Discussion

Conclusion