Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Abstract

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar.