African Journal of Emergency Medicine最新文献

{"title":"Global Health research abstracts: November ‘25","authors":"","doi":"10.1016/j.afjem.2025.100921","DOIUrl":"10.1016/j.afjem.2025.100921","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100921"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute paediatric pain management: A survey of doctors’ knowledge, attitudes and reported practices at regional hospitals in KwaZulu-Natal, South Africa","authors":"Shannon Pillay,&nbsp;Bavani Naicker,&nbsp;Kamlin Ekambaram","doi":"10.1016/j.afjem.2025.100897","DOIUrl":"10.1016/j.afjem.2025.100897","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in both pharmacological and non-pharmacological pain management, children remain vulnerable to oligoanalgesia. Understanding clinical practices and barriers encountered by treating clinicians is essential to inform targeted interventions. This study aimed to examine knowledge, attitudes and reported practices of doctors managing acute paediatric pain in rural regional hospitals in KwaZulu-Natal, South Africa.</div></div><div><h3>Methods</h3><div>An electronic survey was distributed between January and February 2024 to doctors working in the departments of Emergency Medicine, Paediatrics, Surgery, and Orthopaedics at three regional hospitals. The survey included both closed- and open-ended questions addressing analgesic choices, awareness of clinical protocols, and perceived barriers to effective pain management. Descriptive statistics were used to summarise overall trends. Post hoc subgroup analyses were conducted using Chi-square and Fisher’s exact tests. Odds ratios were calculated to describe significant associations.</div></div><div><h3>Results</h3><div>Of 165 clinicians approached, 131 responded (response rate: 80%). Over half (55.7%) reported inadequate training for paediatric pain management, and only 42% were aware of departmental protocols. Paracetamol was the most commonly used analgesic agent. Key barriers included time constraints, limited drug access, and departmental culture. Awareness of departmental paediatric pain protocols was highest (82,9%) in Paediatrics (χ², p&lt;0.001). Paediatric doctors reported significantly greater use of non-pharmacological methods across multiple conditions and procedures. Emergency Medicine respondents more frequently reported opioids for severe abdominal pain (OR=4.24, <em>p</em>&lt;0.001, 95% CI 1.96-9.14). Barriers varied by discipline. Paediatrics cited difficulties with pain assessment, while Orthopaedics primarily reported time and staffing constraints.</div></div><div><h3>Conclusion</h3><div>Paediatric pain remains common yet inadequately addressed in Southern Africa. This study identifies insufficient training, poor access to analgesia, and departmental practices as key barriers. Context-specific, cost-effective, multimodal strategies and tailored education are needed to improve care. Sustainable progress requires cultural change, better training, and interdisciplinary collaboration to ensure equitable pain management.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100897"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the relationship between armed conflict and infectious disease incidence in Six Sub-Saharan Countries: Implications for Emergency Departments in conflict areas","authors":"Andrew Holzman ,&nbsp;Daniel Olinga ,&nbsp;Jacob Busingye ,&nbsp;Douglas Rappaport","doi":"10.1016/j.afjem.2025.100911","DOIUrl":"10.1016/j.afjem.2025.100911","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to update and expand on prior ecological analyses by examining within-country and cross-national correlations between conflict deaths and infectious disease incidence in six neighboring sub-Saharan African countries.</div></div><div><h3>Methods</h3><div>We analyzed six countries including Uganda, Rwanda, the Democratic Republic of the Congo, Central African Republic, South Sudan, and Burundi using conflict death data from the Uppsala Conflict Data Program and disease incidence data from the World Health Organization databases. Data were analyzed for the maximum period covered in the UCDP for each country, in general from 1990 to the present. Seven diseases were examined: malaria, tuberculosis, human immunodeficiency virus, tetanus, pertussis, measles, and yellow fever. We assembled matrices of regressions between conflict deaths and disease incidence within and across countries. The approach of this study was hypothesis-generating, with the intent to flag associations worthy of further consideration.</div></div><div><h3>Results</h3><div>Within-country analyses identified strong positive associations in Burundi (e.g., tuberculosis: R² = 0.81, <em>p</em>&lt;0.001; tetanus: R² = 0.59, <em>p</em>&lt;0.001) and Uganda (e.g., tuberculosis: R² = 0.56, <em>p</em>&lt;0.001; malaria: R² = 0.42, <em>p</em>&lt;0.001). Weaker but statistically significant correlations were also observed with measles in Uganda (R² = 0.13, <em>p</em> = 0.04) and Burundi (R² = 0.29, <em>p</em> = 0.001). Cross-nationally, we observed strong correlations between conflict deaths in Burundi and tuberculosis incidence in Uganda (R² = 0.86, <em>p</em>&lt;0.001) and conflict deaths in South Sudan and malaria in the Democratic Republic of the Congo (R² = 0.64, <em>p</em>&lt;0.001).</div></div><div><h3>Conclusion</h3><div>We confirm prior reports of malaria incidence association with armed conflict while introducing potential new associations involving tetanus and measles. Our hypothesis-generating approach supports further research. Emergency physicians and health systems in conflict-affected and adjacent regions should anticipate shifts in disease burden and consider preparedness strategies.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100911"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: July ‘25","authors":"","doi":"10.1016/j.afjem.2025.100924","DOIUrl":"10.1016/j.afjem.2025.100924","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100924"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of mortality and predictors among patients with shock managed in the emergency room of a tertiary hospital in Ethiopia","authors":"Kalsidagn Girma Asfaw ,&nbsp;Abel Getachew Adugna ,&nbsp;Nahom Mesfin Mekonen ,&nbsp;Merahi Kefyalew Merahi ,&nbsp;Segni Kejela ,&nbsp;Fekadesilassie Henok Moges ,&nbsp;Tigist Workneh Leulseged","doi":"10.1016/j.afjem.2025.100917","DOIUrl":"10.1016/j.afjem.2025.100917","url":null,"abstract":"<div><h3>Introduction</h3><div>Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, including Ethiopia, which hinders the provision of quality care for improved outcomes. Hence, this study aimed to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul’s Hospital Millennium Medical College in Ethiopia.</div></div><div><h3>Methods</h3><div>A retrospective chart review study was conducted among eligible patients managed at the hospital between October 1, 2021 and May 20, 2022. Mortality was estimated with incidence density using person day (PD) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors fitted, where adjusted relative risk (ARR) with 95 % CI was used to interpret results.</div></div><div><h3>Result</h3><div>During the study period, a total of 196 patients were identified for assessment, of which 18 with incomplete records were excluded, resulting in 178 eligible patients for inclusion. The majority of participants were 40 or older (69.7 %) and female (51.1 %), presenting with symptoms lasting less than one week (68.5 %) and had at least one comorbid illness (70.8 %). The incidence of death was 16.5 deaths per 100 PD (95 % CI = 13.1 to 20.9). While triage to orange was associated with a decreased risk of death, high shock index, septic shock diagnosis, vasopressor use, and organ failure were associated with increased risk of death.</div></div><div><h3>Conclusion</h3><div>The incidence of mortality among shock patients was found to be considerable. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100917"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in clinical toxicology in Africa: Emerging applications and barriers","authors":"Mikiyas G. Teferi,&nbsp;Biruk T. Mengistie,&nbsp;Helina K. Teklehaimanot,&nbsp;Chernet T. Mengistie,&nbsp;Fitsum A. Gemechu,&nbsp;Michael A. Negussie,&nbsp;Tilahun J. Jufara,&nbsp;Getaw W. Hassen","doi":"10.1016/j.afjem.2025.100901","DOIUrl":"10.1016/j.afjem.2025.100901","url":null,"abstract":"<div><div>Artificial intelligence (AI) has a supplementary role in clinical toxicology in Africa, addressing key challenges such as delayed diagnoses, limited expertise, and inadequate healthcare infrastructure. This method has the potential to increase diagnostic accuracy, optimize treatment strategies, and advance research on toxic substance exposure and poisoning cases. AI-driven tools, including machine learning algorithms and decision-support systems, enhance the early detection and risk assessment of toxicities. AI-powered predictive models facilitate precision medicine by designing treatment plans for individual patient profiles. Integrating this in telemedicine expands access to toxicology expertise, particularly in resource-limited settings. Additionally, AI accelerates research by analyzing large datasets, identifying trends, and predicting toxicological risks, thus contributing to public health interventions. Despite these advancements, challenges such as data poverty, ethical issues, and restrictive policies hinder its full potential in African healthcare. These gaps can be bridged through policy reforms, capacity-building initiatives, and robust AI frameworks, which will be crucial in maximizing AI benefits for clinical toxicology. This narrative review highlights the emerging applications of AI in Africa, emphasizing the need for collaborative efforts to ensure equitable and effective implementation. However, its adoption is limited by financial constraints, scarce datasets, weak infrastructure, and ethical concerns.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100901"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: September ‘25","authors":"","doi":"10.1016/j.afjem.2025.100923","DOIUrl":"10.1016/j.afjem.2025.100923","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100923"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: October ‘25","authors":"","doi":"10.1016/j.afjem.2025.100922","DOIUrl":"10.1016/j.afjem.2025.100922","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100922"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric procedural sedation and or analgesia in the emergency unit; A descriptive study of practice at a Ugandan Referral Hospital","authors":"Anna Meridah Kaguna ,&nbsp;John Mark Mayanja Kasumba ,&nbsp;Mary Ellen Lyon ,&nbsp;Jonathan Byasi ,&nbsp;Celine Jacobs ,&nbsp;Rachael Parke","doi":"10.1016/j.afjem.2025.100929","DOIUrl":"10.1016/j.afjem.2025.100929","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric Procedural Sedation and/ or Analgesia (PPSA) is the recommended standard of practice for children undergoing painful and distressing procedures outside the operating room; however, global practice may vary. In Sub-Saharan Africa, data on the practice of PPSA is lacking. This study aimed to determine the current practice and outcomes of PPSA in the Emergency unit of Mulago National Referral Hospital to inform future standardisation of care.</div></div><div><h3>Methods</h3><div>We conducted a descriptive study from 1st October to 31st December 2023 in the surgical section of the emergency unit of Mulago National Referral Hospital. Data was collected using specifically designed and pretested observational checklists, documenting demographics, pre-procedure assessment and preparation, intra-procedural and post-procedural care, average sedation scores attained, pain control and adverse events observed. Data was coded using EPI-Data and analysed to describe PPSA practice and outcomes.</div></div><div><h3>Results</h3><div>We recruited 183 children undergoing procedures at the surgical section of the emergency unit. Majority were male, 104(56.8 %), and the median age (IQR) was 8 (4–12)years. Most procedures performed were orthopaedic, 149(81.4 %). Only 15(8.2 %) children got both sedation and analgesia, 4(2.2 %) got sedation only while 164(89.6 %) got analgesia only. Propofol was the most used sedative, while lignocaine with paracetamol was the most used analgesia. Most children, 92(50.3 %), had pain scores ≥8, and adverse events occurred in 6(3.3 %), all of whom belonged to the sedation and analgesia group. Anaesthetic officers were the primary providers in 75 % of the sedation-only cases and 46.7 % of the sedation and analgesia group.</div></div><div><h3>Conclusion</h3><div>PPSA practice in this Emergency setting deviates from recommended standards with limited monitoring and inadequate pain control. The clustering of adverse events among children receiving both sedation and analgesia underscores safety risks. Safer sedative choices, clear provider roles, local guidelines, and targeted training are needed to improve the safety and quality of PPSA.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100929"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of shock index, lactate and physician’s gestalt in predicting adverse events among critically ill adult patients at an Emergency Department in Tanzania","authors":"Humphrey G. Medarakini ,&nbsp;Alphonce N. Simbila ,&nbsp;Ellen Weber ,&nbsp;Zeinab B. Hassan ,&nbsp;Florian Vedasto ,&nbsp;Jennifer Tesha ,&nbsp;Rebecca N. Tugara ,&nbsp;Peter P. Kunambi ,&nbsp;Elizabeth Bernard ,&nbsp;Said S. Kilindimo","doi":"10.1016/j.afjem.2025.100914","DOIUrl":"10.1016/j.afjem.2025.100914","url":null,"abstract":"<div><h3>Introduction</h3><div>Physicians working in Emergency Departments (ED) must be able to identify critically ill patients likely to deteriorate and prioritize their care. While shock index, point of lactate and physician gestalt are commonly used in high-income countries to predict adverse events their applicability has not been widely tested in low-middle income countries.</div></div><div><h3>Methods</h3><div>A prospective cohort study of all adult patients (≥18 years) triaged to the resuscitation area of Muhimbili ED in Tanzania from 1^st September - 31^st December 2022. Shock index (SI) on arrival, initial point of care lactate and the physician’s estimates of the probability of an adverse event were recorded. The discriminatory ability of these index tests was compared for prediction of an adverse event in the ED, using DeLong’s test. Sensitivity, specificity, positive and negative predictive values were calculated. For SI, a standard cut off ≥ 1 was used and for lactate a standard cut off &gt; 2 mmol/L was used. For physician gestalt, the optimum cut off of a 70 % probability of adverse event was determined based on Youdens’ index.</div></div><div><h3>Results</h3><div>A total of 320 critically ill patients were enrolled. SI (AUC = 0.734, 95 % CI 0.658 to 0.810) achieved a sensitivity of 59.3 % and a specificity of 83.1 %. Elevated lactate (AUC = 0.819, 95 % CI 0.76 to 0.88) achieved a sensitivity of 89.8 % and a specificity of 58.2 %. Physician gestalt had an AUC = 0.877, (95 % CI 0.833 to 0.922) using the optimal probability of ≥70 % and achieved a sensitivity of 88.1 % and a specificity of 76.2 %. The AUC of physician’s gestalt was significantly higher than that of SI (<em>p</em> = 0.0008), but was not significantly different from lactate (<em>p</em> = 0.067). The difference in AUC for lactate and SI was also not statistically significant (<em>p</em> = 0.10).</div></div><div><h3>Discussion</h3><div>Physicians gestalt in our setting demonstrated superior predictive performance compared to shock index and a comparable performance to lactate. This supports the use of gestalt as a low-resource risk stratification tool in emergency settings. However, accuracy of gestalt may depend on physician experience.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100914"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}