Fifteen years of emergency medicine literature in Africa: A scoping review

Abstract

Introduction Emergency medicine (EM) throughout Africa exists in various stages of development. The number and types of scientific EM literature can serve as a proxy indicator of EM regional development and activity. The goal of this scoping review is a preliminary assessment of potential size and scope of available African EM literature published over 15 years. Methods We searched five indexed international databases as well as non-indexed grey literature from 1999-2014 using key search terms including “ Africa”, “emergency medicine”, “emergency medical services”, and “disaster.” Two trained physician reviewers independently assessed whether each article met one or more of five inclusion criteria, and discordant results were adjudicated by a senior reviewer. Articles were categorised by subject and country of origin. Publication number per country was normalised by 1,000,000 population. Results Of 6091 identified articles, 633 (10.4%) were included. African publications increased 10-fold from 1999 to 2013 (9 to 94 articles, respectively). Western Africa had the highest number (212, 33.5%) per region. South Africa had the largest number of articles per country (171, 27.0%) followed by Nigeria, Kenya, and Ghana. 537 (84.8%) articles pertained to facility-based EM, 188 (29.7%) to out-of-hospital emergency medicine, and 109 (17.2%) to disaster medicine. Predominant content areas were epidemiology (374, 59.1%), EM systems (321, 50.7%) and clinical care (262, 41.4%). The most common study design was observational (479, 75.7%), with only 28 (4.4%) interventional studies. All-comers (382, 59.9%) and children (91, 14.1%) were the most commonly studied patient populations. Undifferentiated (313, 49.4%) and traumatic (180, 28.4%) complaints were most common. Conclusion Our review revealed a considerable increase in the growth of African EM literature from 1999 to 2014. Overwhelmingly, articles were observational, studied all-comers, and focused on undifferentiated complaints. The articles discovered in this scoping review are reflective of the relatively immature and growing state of African EM.

The State of Emergency Medical Services (EMS) Systems in Africa

“…Questionnaire data were entered and stored in a database in Microsoft Excel (Microsoft Corporation; Redmond, Washington USA). An estimate of the population size served by the jurisdictional EMS system was computed using survey geographic data and the country-specific census data available online 18 32 Results were analyzed in Microsoft Excel using descriptive statistics with percentages, ranges, and means.…”

Emergency Medical Services (EMS) Utilization in Zimbabwe: Retrospective Review of Harare Ambulance System Reports

“…This finding suggests a major need for competent trauma specific emergency services. However, across numerous African countries, patients with emergency traumatic conditions are often limited in their ability to directly access higher level hospitals [ 9 10 14 27 ]. Similar to maternity patients, a lack of rapid transport is a critical barrier to timely trauma care, and correspondingly, to improving outcomes [ 24 28 ].…”

“…Yet, only one third of African countries have EMS [ 7 8 ]. Currently in Africa, EMS ranges from basic transport by non-medical providers to advanced services with trained paramedics, including air transport [ 9 ]. Most EMS in Africa is a pay-for-service model, with some countries having varying combinations of private, government, and charity-run ambulance systems [ 10 11 ].…”

Systemic emergency department performance in a low resource tertiary health facility in central Kenya: Micro level emergency care system evaluation

“…The Emergency Care System (ECS) reflects on emergency response and health systems resilience [1] . Emergency Care (EC) in Kenya has evolved significantly over the past decade [2] however, emergency department (ED) performance lacks consensus on specific metrics [3] . We have validated tools that assess hospital-based ED capacity [ 4 , 5 ] however, few studies assess the ECS locally.…”

“…We have validated tools that assess hospital-based ED capacity [ 4 , 5 ] however, few studies assess the ECS locally. European and American metrics are non-representative of our local priority areas [ 2 , 6 ]. Local assessment of EC capacity [7] , analysis of clinical practice in Kenyan ED [8] and country specific ECS assessment in Africa [5] highlight some metrics but none qualifies ED performance in the context of the entire health care system, beyond the ED capacity.…”