BackgroundPoint of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania.MethodsThis was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital’s Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences.ResultsPoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed.ConclusionsIn resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.

Background: Abdominal pain in adults represents a wide range of illnesses, often warranting immediate intervention. This study is to fill the gap in the knowledge about incidence, presentation, causes and mortality from abdominal pain in an established emergency department of a tertiary hospital in Tanzania. Methods: This was a prospective cohort study of adult (age ≥ 18 years) patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Dar Es Salaam, Tanzania with non-traumatic abdominal pain from September 2017 to October 2017. A case report form was used to record data on demographics, clinical presentation, management, diagnosis, outcomes and patient follow-up. The primary outcome of mortality was summarized using descriptive statistics; secondary outcome was, risks for mortality.Results: Among 3381 adult patients present during the study period, 288 (8.5%) presented with abdominal pain, and of these 199 (69%) patients were enrolled in our study. Median age was 47 years (IQR 35-60 years), 126 (63%) were female, and 118 (59%) were referred from another hospital. Most common final diagnoses were malignancies 71 (36%), intestinal obstruction 11 (6%) and peptic ulcer disease 9 (5%). Most common EMD interventions given were intravenous fluids 57 (21%), analgesia 49 (25%) and antibiotics 40 (20%). 160 (80%) were admitted of which 15 (8%) underwent surgery directly from EMD. 24-h and 7-day mortality were 4 (2%) and 7 (4%) respectively, while overall in hospital-mortality was 16 (8%). Among the risk factors for mortality were male sex Relative Risk (RR) 2.88 (p = 0.03), hypoglycemia (RR) 5.7 (p = 0.004), ICU admission (RR) 14 (p < 0.0001), receipt of IV fluids (RR) 3.2 (p = 0.0151) and need for surgery (RR) 6.6 (p = 0.0001).

Background Tanzania has no formal prehospital system. The Tanzania Ministry of Health launched a formal prehospital system to address this gap. The Muhimbili University of Health and Allied Sciences (MUHAS) was tasked by the Ministry of Health to develop and implement a multicadre/provider prehospital curriculum so as to produce necessary healthcare providers to support the prehospital system. We aim to describe the process of designing and implementing the multicadre/provider prehospital short courses. The lessons learned can help inform similar initiatives in low- and middle-income countries. Methods MUHAS collaborated with local and international Emergency Medicine and Emergency Medical Services (EMS) specialists to form the Emergency Medical Systems Team (EMST) that developed and implemented four short courses on prehospital care. The EMST used a six-step approach to develop and implement the curriculum: problem identification, general needs assessment, targeted needs assessment, goals and objectives, educational strategies, and implementation. The EMST modified current best EMS practices, protocols, and curricula to be context and resource appropriate in Tanzania. Results We developed four prehospital short courses: Basic Ambulance Provider (BAP), Basic Ambulance Attendant (BAAT), Community First Aid (CFA), and EMS Dispatcher courses. The curriculum was vetted and approved by MUHAS, and courses were launched in November 2018. By the end of July 2019, a total of 63 BAPs, 104 BAATs, 25 EMS Dispatchers, and 287 CFAs had graduated from the programs. The main lessons learned are the importance of a practical approach to EMS development and working with the existing government cadre/provider scheme to ensure sustainability of the project; clearly defining scope of practice of EMS providers before curriculum development; and concurrent development of a multicadre/provider curriculum to better address the logistical barriers of implementation. Conclusion We have provided an overview of the process of designing and implementing four short courses to train multiple cadres/providers of prehospital system providers in Tanzania. We believe this model of curricula development and implementation can be replicated in other countries across Africa.

Background: Proper pain assessment is a core component in management of trauma patients but prior literature has suggested that pain management is inadequate in emergency settings. With the development of emergency medicine in low-income countries (LIC), the procedures for pain assessment and management of trauma patients have not been well studied and protocols have not been established. We aimed to describe practices of pain assessment and management in an emergency department in Tanzania. Methods: This was a prospective cohort study of consecutive adult trauma patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Dar es Salaam, Tanzania, from July 2017 to December 2017. A case report form (CRF) was used to record demographics and clinical characteristics of participants, whether or not pain was assessed at either triage or in the treatment area, and the administration of pain medications. The assistant also assessed pain independently with the numeric rating scale (NRS) of (0-10). Outcomes were proportions of patients who received pain assessment, patients who received pain medication, and types of medications administered. Descriptive data is summarised using frequency, percentage, and median with interquartile ranges as appropriate. Chi-square tests were used to determine association between pain assessments, receipt of pain medication, and types of medications. Results: We enrolled 311 (10.9%) trauma patients during the period of study. The median age was 32 years (IQR 25-43 years), and 228 (73.3%) were male. The most common mechanism of injury was motor vehicle crash 185 (59.4%), and of these, 87 (47%) involved motorcycles. Three hundred ten (99.6%) patients had pain assessment documented arrival, and 285 (91.6%) had a second assessment. Pain scores obtained by the research assistant were as follows: mild pain score (NRS 1-3) 154 (49.5%) patients, moderate pain (NRS 4-6) 68 (21.8%), and severe pain (NRS 7-10) 89 (28.7%). Pain medications were given to 144 (46.3%) patients, 29 (20.1%) of those with mild pain, 41 (28.7%) of those with moderate pain score, and 74 (51.4%) of those with severe pain. The use of opiates increased with increased pain severity. Conclusions: In this ED in LIC, the assessment of pain was well documented; however, less than half of patients with documented pain received pain medication while at the ED. Future studies should focus on identification of factors affecting the provision of pain medications to trauma patients in the ED.

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