Background The emergency care of time-sensitive injuries and illnesses is increasingly recognized as an essential component of effective health care systems. However, many low- and middle-income countries (LMICs) lack healthcare providers formally trained in the care of emergency conditions. The Disease Control Priorities 3 project estimates that effective emergency care systems could avert up to half of all premature deaths in LMICs. Nigeria, a lower-middle income country of nearly 200 million people in Sub-Saharan Africa, could save approximately 100,000 lives per year with an effective emergency care system. The World Health Organization developed the Basic Emergency Care (BEC) course to train frontline healthcare workers in the management of emergency conditions in low resource settings. In this study we describe our work implementing the BEC course Nigeria. Methods This study was designed as a mixed methods research analysis comparing pre- and post- course examination results and surveys to evaluate participant knowledge acquisition and levels of confidence with management of various emergency conditions. Thirty-two participants were involved in the course which took place over four days at the Lagos University Teaching hospital. Quantitative data was analyzed using Stata 14.2 (College Station, TX). Paired data sets were analyzed using McNemar's chi-squared. Unpaired data sets were analyzed using a Wilcoxon signed-rank test. Results Post-course test scores showed significant improvement (p-value <0.001) as compared to pre-course. The average pre-course test score was 73% and average post-course score was 86.5%. Pre- and post-course questionnaires demonstrated significantly increased confidence in managing emergency conditions and agreement with course objectives. Conclusions The WHO Basic Emergency Care (BEC) course successfully increased the knowledge and confidence of frontline emergency care providers in Nigeria. The course was well received by participants. Future study should focus on BEC course scalability and long-term knowledge retention.
IntroductionEmergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.MethodsParticipants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.ResultsThree descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.ConclusionsThe participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.
n spite of published reports highlighting the need to increase the number of physicians who identify with groups underrepresented in medicine (UiM), Black and Hispanic individuals each made up only 5% and 5.8%, respectively, of US physicians in 2019. 1,2 Due to these small numbers, UiM trainees often lack access to a community of coresidents, fellows, faculty, and mentors from similar racial or ethnic backgrounds. The deficiency of social support from individuals of similar backgrounds has been reported to hinder the personal and professional success of UiM trainees. 3-5 Decades Without Adequate Progress Since 1964, the Student National Medical Association (SNMA) has provided a diverse and welcoming community for medical students. Similarly, since 1895, the National Medical Association (NMA) has provided the same benefits to UiM faculty members. 6 These communities are designed to improve the recruitment, success, and retention of UiM physicians. However, there is a gap in a structured community specifically designed for UiM physicians enrolled in graduate medical education (GME). How does a health care system intentionally foster a community for diverse GME trainees and cultivate a support system for UiM trainees? There is a paucity of evidence outlining best practice strategies for building community among UiM GME trainees. We share a guide we used to fill this gap through the creation of a house staff diversity council (HSDC) at
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