Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census
Abstract Background Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of h...
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doaj-7748d45692514164a3a88bfca375b91a2020-11-25T03:04:33ZengBMCBMC Public Health1471-24582020-06-0120111110.1186/s12889-020-09043-3Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility censusEmily White Johansson0Cecilia Lindsjö1Daniel J. Weiss2Humphreys Nsona3Katarina Ekholm Selling4Norman Lufesi5Helena Hildenwall6Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala UniversityDepartment of Public Health Sciences, Global Health – Health System and Policy Research Group, Karolinska InstitutetOxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of OxfordMinistry of Health, Integrated Management of Childhood Illness (IMCI) UnitDepartment of Women’s and Children’s Health, International Maternal and Child Health, Uppsala UniversityMinistry of Health, Community Health Sciences UnitDepartment of Public Health Sciences, Global Health – Health System and Policy Research Group, Karolinska InstitutetAbstract Background Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi’s population distribution. Methods We analysed a Malawi national facility census in 2013–2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results Four (3.5, 95% CI: 1.3–8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4–43.6), blood typing services (40.4, 95% CI: 31.9–49.6), micro nebulizers (50.9, 95% CI: 41.9–60.0), and radiology (54.2, 95% CI: 45.1–63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67–77) ranging 1–507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%, p < 0.001). Conclusions There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.http://link.springer.com/article/10.1186/s12889-020-09043-3MalawiEmergency carePaediatricsHealth systems |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emily White Johansson Cecilia Lindsjö Daniel J. Weiss Humphreys Nsona Katarina Ekholm Selling Norman Lufesi Helena Hildenwall |
spellingShingle |
Emily White Johansson Cecilia Lindsjö Daniel J. Weiss Humphreys Nsona Katarina Ekholm Selling Norman Lufesi Helena Hildenwall Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census BMC Public Health Malawi Emergency care Paediatrics Health systems |
author_facet |
Emily White Johansson Cecilia Lindsjö Daniel J. Weiss Humphreys Nsona Katarina Ekholm Selling Norman Lufesi Helena Hildenwall |
author_sort |
Emily White Johansson |
title |
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census |
title_short |
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census |
title_full |
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census |
title_fullStr |
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census |
title_full_unstemmed |
Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census |
title_sort |
accessibility of basic paediatric emergency care in malawi: analysis of a national facility census |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2020-06-01 |
description |
Abstract Background Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi’s population distribution. Methods We analysed a Malawi national facility census in 2013–2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results Four (3.5, 95% CI: 1.3–8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4–43.6), blood typing services (40.4, 95% CI: 31.9–49.6), micro nebulizers (50.9, 95% CI: 41.9–60.0), and radiology (54.2, 95% CI: 45.1–63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67–77) ranging 1–507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%, p < 0.001). Conclusions There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk. |
topic |
Malawi Emergency care Paediatrics Health systems |
url |
http://link.springer.com/article/10.1186/s12889-020-09043-3 |
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