Abstract
BackgroundThe global agenda does not address a significant amount of preventable death in low- and middle-income countries (LMICs). While illnesses requiring acute care are increasing at an alarming rate in these countries, there are inadequate numbers of physicians or nurses to deal with the growing burden. Many people feel that emergency systems are too expensive and restricted in scope to have public health implications in resource-limited areas. Little empirical data exists to suggest otherwise. The goal of this study was to delineate the type and frequency of emergency conditions and define a novel method to estimate the burden of emergency diseases in Fort Liberte, Haiti.MethodsA retrospective, cross-sectional medical record review was performed on all emergency room visits to Fort Liberte Hospital in 2009 and 2010. The type, frequency, and annual incidence of emergency conditions were identified and used to determine the burden of emergency disease. A disability-adjusted life year (DALY) calculation was estimated using a variation on a model of indirect national data extrapolation to cities.ResultsNineteen months of data available yielded 2000 charts with 2284 diagnoses in total. Trauma was the most common illness at 13% of all charts, followed by abdominal pain at 11%, gastroenteritis at 8%, skin and soft tissue infections at 7%, and hypertension at 6%. The DALY calculation showed disability from emergency conditions to be five times that of HIV, malaria, and TB combined.ConclusionsSufficient emergency burden of disease affects population health in Fort Liberte, Haiti to warrant addressing it as a public health concern. The kinds of conditions described in this review may be amenable to task shifting as a feasible, sustainable, and scalable way to address the burden in a cost-effective manner.
Highlights
Global health agencies historically forego development of emergency systems in favor of primary care as a low-cost way to provide care for the most people in low- and middle-income countries (LMICs) [1]
While illnesses requiring acute care are increasing at an alarming rate in these countries, there are inadequate numbers of physicians or nurses to deal with the growing burden
Sufficient emergency burden of disease affects population health in Fort Liberte, Haiti to warrant addressing it as a public health concern
Summary
Global health agencies historically forego development of emergency systems in favor of primary care as a low-cost way to provide care for the most people in low- and middle-income countries (LMICs) [1]. The World Health Organization (WHO) allocates resources for the development of health programs by the disease-based assessment of mortality and disability from 107 diseases and injuries [3,4,5,6,7] This assessment, termed as the Global Burden of Disease (GBD), measures the burden of disease in a population by calculating the disability-adjusted life year (DALY), the number of years of life lost in a population due to ill health, disability, or death. The inability to separate and quantify emergency processes for a vast number of diseases obscures the need for emergency care in a population This lack of quantitative data has been proposed to be one reason that developing emergency health systems have been overlooked in LMICs. Further, many feel that despite the apparent increasing burden of emergency disease, emergency systems are too expensive, individualistic, and restricted in scope to have public health implications in resource-limited areas. The goal of this study was to delineate the type and frequency of emergency conditions and define a novel method to estimate the burden of emergency diseases in Fort Liberte, Haiti
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