Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes

Abstract

BackgroundDue to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients.MethodsNurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit.FindingsOverall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives.InterpretationThis study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.

Mortality in Children Under Five Receiving Nonphysician Clinician Emergency Care in Uganda

“…10,19 Because baseline mortality data for this region of Uganda are not available, this study evaluated the effectiveness of independent NPC care by comparing the mortality of supervised care with unsupervised care.…”

“…8 Though nonphysician clinicians (NPCs) have provided basic diagnosis, medical treatment, and surgical specialty care in SSA, 9 NPC cadres have only recently begun treating undifferentiated patients in an emergency department (ED) setting. 10,11 The Global Emergency Care Collaborative (GECC) is a US-based nongovernmental organization that started the Emergency Care Practitioner (ECP) program in Uganda in 2009 to train NPCs specialized in emergency care. A detailed description of the ECP training program was previously published.…”

Nurse managers’ experiences in continuous quality improvement in resource‐poor healthcare settings

“…Rural hospitals in the African region, including Uganda, are perceived as the poorest care settings in resource‐poor countries. However, they were vital in achieving the United Nations (UN) Millennium Development Goals (MDGs) in the past and have an important role to play to achieve the UN Sustainable Development Goals (SDG) related to health, considering that the majority of the population in this region live in rural areas (Hammerstedt et al ., ; Chamberlain et al ., ). Uganda shares the most common public health issues in African regions, including malaria, HIV/AIDS, tuberculosis, pneumonia, perinatal conditions, and injuries among children and adults (Ministry of Health & Makerere University School of Public Health, ).…”

Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda

“…Nurses underwent two years training program to become emergency care practitioners in rural settings. It was found to have had significant impact on mortality indices in the region compared to data before the implementation of the program 25 . As far as the lack of space/ infrastructure is concerned, it is a general problem in the country similar in other regions as well as other countries like Kenya and Tanzania with similar settings.…”