ObjectiveTo conduct a systematic review of emergency care in low- and middle-income countries (LMICs).MethodsWe searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.FindingsWe identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.ConclusionAvailable data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.

We conducted an observational study to identify predictors of hand hygiene (HH) in the emergency department. Compliance with HH was 89.7% over 5,865 opportunities. Observation unit, hallway or high-visibility location, glove use, and worker type predicted worse HH. Hallway location was the strongest predictor (relative risk, 88.9% [95% confidence interval, 85.9%-92.1%]).

The following is a population-based survey of the Central African Republic (CAR) female refugee population displaced to rural Djohong District of Eastern Cameroon and associated female Cameroonian host population to characterise the prevalence and circumstances of sexual violence. A population-based, multistage, random cluster survey of 600 female heads of household was conducted during March 2010. Women heads of household were asked about demographics, household economy and assets, level of education and sexual violence experienced by the respondent only. The respondents were asked to describe the circumstances of their recent assault. The lifetime prevalence of sexual violence among Djohong district female heads of household is 35.2% (95% CI 28.7-42.2). Among heads of household who reported a lifetime incident of sexual violence, 64.0% (95% CI 54.3-72.5) suffered sexual violence perpetrated by their husband or partner. Among the host population, 3.9% (95% CI 1.4-10.5) reported sexual violence by armed groups compared to 39.0% (95% CI 25.6-54.2) of female refugee heads of household. Women who knew how to add and subtract were less likely to report sexual violence during their lifetime (OR 0.16, 95% CI 0.08-0.34). Sexual violence is common among refugees and host population in Eastern Cameroon. Most often, perpetrators are partners/husbands or armed groups.

The collaborative London based non-governmental organization network ELRHA (Enhancing Learning and Research for Humanitarian Assistance) supports partnerships between higher education institutions and humanitarian organizations worldwide with the objective to enhance the professionalization of the humanitarian sector. While coordination and control of the humanitarian sector has plagued the response to every major crisis, concerns highlighted by the 2010 Haitian earthquake response further catalyzed and accelerated the need to ensure competency-based professionalization of the humanitarian health care work force. The Harvard Humanitarian Initiative sponsored an independent survey of established academically affiliated training centers in North America that train humanitarian health care workers to determine their individual training center characteristics and preferences in the potential professionalization process. The survey revealed that a common thread of profession-specific skills and core humanitarian competencies were being offered in both residential and online programs with additional programs offering opportunities for field simulation experiences and more advanced degree programs. This study supports the potential for the development of like-minded academic affiliated and competency-based humanitarian health programs to organize themselves under ELRHA's regional "consultation hubs" worldwide that can assist and advocate for improved education and training opportunities in less served developing countries.