African Journal of Emergency Medicine最新文献

{"title":"Acute coronary syndrome prevalence and outcomes in a Tanzanian emergency department: Results from a prospective surveillance study","authors":"Julian T Hertz , Francis M Sakita , Wai Yan Min Htike , Kilonzo G Kajiru , Blandina T Mmbaga , Tumsifu G Tarimo , Godfrey L Kweka , Jerome J Mlangi , Amedeus V Maro , Lauren Coaxum , Sophie W Galson , Alexander T Limkakeng , Gerald S Bloomfield","doi":"10.1016/j.afjem.2024.11.003","DOIUrl":"10.1016/j.afjem.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Preliminary data suggests that the burden of acute coronary syndrome (ACS) is high in Tanzania. After efforts to improve ACS care, we sought to describe ACS diagnosis rates, care processes, and outcomes in a Tanzanian Emergency Department (ED).</div></div><div><h3>Methods</h3><div>Adults presenting to a northern Tanzanian ED with acute chest pain or shortness of breath were enrolled from November 2020 to January 2023. ACS was defined as per Fourth Universal Definition of Myocardial Infarct criteria. All treatments given in the ED were observed and recorded. Thirty-day follow-up was conducted with all participants via telephone or home visit.</div></div><div><h3>Results</h3><div>Of 568 participants with chest pain or shortness of breath, 129 (22.7 %) had ACS, including 61 (47 %) with STEMI and 68 (53 %) with non-STEMI. Of participants with ACS, 77 (59.7 %) were male, and the mean (SD) age was 64.5 (16.6) years. The mean duration of symptoms among ACS participants prior to presentation was 2.9 (3.0) days, and 26 (20.2 %) reported no known medical comorbidities. In the ED, 39 (30.2 %) participants with ACS received aspirin and 33 (25.6 %) received clopidogrel. Follow-up was achieved for all 129 ACS participants; 42 (32.6 %) of participants with ACS died within 30 days of presentation. Participants with ACS were significantly more likely to die within 30 days than participants without ACS (32.6 % vs 16.4 %, OR 2.45, 95 % CI: 1.56–3.83, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>ACS is common in a northern Tanzanian ED. Interventions are needed to improve uptake of evidence-based ACS care and reduce ACS-associated mortality.</div></div><div><h3>African relevance</h3><div><ul><li><span>•</span><span><div>The study found that 22.7 % of adults presenting with chest pain or shortness of breath in the Tanzanian emergency department (ED) had acute coronary syndrome (ACS). This high prevalence highlights the critical need for enhanced cardiovascular diagnostic and treatment capabilities in Tanzanian and similar African healthcare settings.</div></span></li><li><span>•</span><span><div>The research reveals significant challenges in managing ACS within resource-constrained settings, where limited access to advanced diagnostic tools like ECGs and cardiac biomarkers contributes to delayed or missed diagnoses, ultimately leading to worse patient outcomes. This situation reflects broader healthcare limitations across sub-Saharan Africa.</div></span></li><li><span>•</span><span><div>Thirty-day mortality among ACS patients in this study was extremely high (32.6 %), which is substantially higher than ACS mortality rates in high-income countries. These findings underscore the need for urgent interventions to address critical gaps in ACS care in African emergency departments.</div></span></li><li><span>•</span><span><div>By providing the first prospective data on ACS prevalence and outcomes in a Tanzanian ED, this stud","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 518-525"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: October ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.233","DOIUrl":"10.1016/j.afjem.2024.10.233","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 539-540"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda","authors":"Sulaiman Bugosera Wasukira ,&nbsp;Carl Trevor Kambugu ,&nbsp;Judith Nanyondo S ,&nbsp;Emmanuel Candia ,&nbsp;Stephen Emmanuel Aporu ,&nbsp;Patricia Ikwaru ,&nbsp;Racheal Kwagala ,&nbsp;Andrew Kwiringira ,&nbsp;Peter Mukiibi ,&nbsp;Costance Murungi ,&nbsp;Marek Ma ,&nbsp;Celine Jacobs ,&nbsp;Cliff Asher Aliga ,&nbsp;Afizi Kibuuka ,&nbsp;Dathan M. Byonanebye ,&nbsp;Sylvia Natukunda ,&nbsp;Kenneth Bagonza ,&nbsp;Rose Muhindo ,&nbsp;Prisca Kizito ,&nbsp;Benard Toliva Opar ,&nbsp;Annet Alenyo-Ngabirano","doi":"10.1016/j.afjem.2025.01.001","DOIUrl":"10.1016/j.afjem.2025.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We describe the curriculum development and rollout using a cascade model.</div></div><div><h3>Methods</h3><div>In June 2021, the World Health Organisation (WHO) Hospital Emergency Unit Assessment Tool (HEAT) was used to assess emergency units and document existing capacity gaps in regional referral hospitals and general hospitals. The WHO Basic Emergency Care curriculum was modified to a training curriculum for emergency care principles for COVID-19 management. Training of trainers was conducted across 14 health regions in July and August 2021. The trainers trained cascaded the training through facility-based training during continuous professional development sessions.</div></div><div><h3>Results</h3><div>Using the HEAT, 115 health facilities (14 regional and 101 general hospitals) were assessed. Only 31.3% (36/115) of the health facilities had a formal triage system. 53.5% (54/101) of general hospitals lacked non-rotating staff in the emergency unit. Some 511 healthcare workers from 205 facilities were trained as trainers, of whom 51.8% were nurses. The trainers trained cascaded the training to 3,550 healthcare workers. There was a significant difference between the overall median pre-test (71%) and median post-test (86.8%) scores of trainers trained (<em>p</em>&lt;0.001).</div></div><div><h3>Conclusion</h3><div>There was a general lack of emergency unit protocols and a shortage of fixed staff at the emergency units. The cascade model facilitated the dissemination of emergency care knowledge to seven times more healthcare workers than the trainers trained. This demonstrates the efficiency of this approach in knowledge dissemination and its ability to be replicated in other low resource settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 565-570"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: April ‘24","authors":"Dr Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.230","DOIUrl":"10.1016/j.afjem.2024.10.230","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 561-562"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: November ‘24","authors":"Dr. Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.225","DOIUrl":"10.1016/j.afjem.2024.10.225","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 555-557"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: May ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.231","DOIUrl":"10.1016/j.afjem.2024.10.231","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 541-542"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needs assessment and Acceptability of a Community First Aid Responder programme to increase Out-of-hospital capacity in Kinshasa, Democratic Republic of Congo: A qualitative study","authors":"K Diango ,&nbsp;J Pigoga ,&nbsp;E Mafuta ,&nbsp;J Yangongo ,&nbsp;L Wallis ,&nbsp;C Cunningham ,&nbsp;P Hodkinson","doi":"10.1016/j.afjem.2024.12.003","DOIUrl":"10.1016/j.afjem.2024.12.003","url":null,"abstract":"<div><h3>Objective</h3><div>Despite efforts in recent years to expand the availability of prehospital care in low- and middle-income countries, its availability remains limited in many regions. The World Health Organization advocates the development of layperson first responder programmes as a supportive step in building functioning prehospital systems. This study aimed to identify the need for, and acceptability of, a community first responder programme to increase out-of-hospital capacity in Kinshasa, Democratic Republic of Congo.</div></div><div><h3>Methods</h3><div>We conducted five focus group discussions using purposive sampling. We included health system planners, emergency care providers, community health volunteers, and community members in both urban and peri‑urban areas. Interviews were recorded and transcribed verbatim, validated, and subjected to inductive content analysis to identify themes and sub-themes.</div></div><div><h3>Results</h3><div>Several areas of the emergency care system were identified for improvement, starting with the initial response to emergencies in the community. Barriers included planning and governance issues; inadequate resources such as trained staff; cost; transportation issues; and reliance on alternative forms of care. There was a dominant view that sustainably addressing these barriers and building on identified facilitators requires a multi-pronged approach involving government, healthcare, and community members. Perspectives about the acceptability and sustainability of a community first responder programme were largely positive, and numerous actionable recommendations were provided.</div></div><div><h3>Conclusion</h3><div>A community first responder programme was deemed a useful and acceptable intervention to help increase out-of-hospital emergency care capacity in Kinshasa. Key potential facilitators and barriers to its implementation and sustainability were identified.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 526-534"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa","authors":"Keabetsoe Hlanze ,&nbsp;Kylen Swartzberg ,&nbsp;Mike Wells","doi":"10.1016/j.afjem.2024.11.001","DOIUrl":"10.1016/j.afjem.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.</div></div><div><h3>Methods</h3><div>A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.</div></div><div><h3>Results</h3><div>Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.</div></div><div><h3>Conclusion</h3><div>The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 513-517"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: June ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.226","DOIUrl":"10.1016/j.afjem.2024.10.226","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 535-536"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health research abstracts: January ‘24","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.10.229","DOIUrl":"10.1016/j.afjem.2024.10.229","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 545-547"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}