Assessing the impact of a low-cost WHO intervention package for emergency units in two hospitals in Uganda. Pubblico
Pigoga, Jennifer Lee (Spring 2018)
Published
Abstract
Objective
Abstract
Assessing the impact of a low-cost WHO intervention package for emergency units in two hospitals in Uganda.
By Jennifer Lee Pigoga, M.Sc
Emergency care is widely recognized as a cost- and time-effective means of reducing death and disability from a wide range of clinical presentations, yet there exists a lack of data surrounding context-appropriate emergency care interventions, particularly in low-resource areas. WHO created a set of simple process guidance documents and tools that can be implemented at very low cost to improve the delivery of emergency care without imposing additional resource requirements. These include: the WHO Basic Emergency Care short course, a consensus-based triage tool, trauma and medical care checklists, and process guidance for designating a resuscitation area for high-acuity patients. Our study sought to address the impact on early mortality of implementing these low-cost initiatives on key emergency conditions at two frontline hospital Emergency Units (EUs) in Uganda.
Methods
Thirteen months of pre-intervention data were collected on all patients presenting to the EUs of Kawolo General Hospital and Mubende Regional Referral Hospital with five key emergency conditions - pediatric diarrhea, pediatric pneumonia, road traffic accidents, postpartum hemorrhage, and asthma - using a standardized, tablet-based data abstraction form. The intervention package was then implemented over a period of seven days, after which the data collection continued.
In this interim analysis, and pre-intervention data and nine months of post intervention data were analyzed via regression to evaluate a primary outcome of 48-hour mortality. Findings We found that the implementation of a simplistic, low-cost package of emergency care interventions in EUs had significant, lasting effects on mortality associated with key emergency conditions. Kawolo saw a 74.3% relative reduction in mortality (2.33% to 0.60%, p = 0.0205), and Mubende, a 44.4% relative reduction (4.71% to 2.62%, p = 0.0122).
Conclusion
The intervention package has the potential to significantly reduce mortality due to conditions that are widely recognized as contributing to the high morbidity and mortality of acute disease, including mortality in vulnerable populations such as children under five years of age. Alongside demographic and burden of disease data also generated by the study, impact data can be used by policymakers, planners, and providers alike to inform future systems improvement initiatives and patient care.
Table of Contents
Special pages: p1-5
Manuscript: p6-19
References: p20-22
Appendices: p23-29
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