Trends in mortality associated with opening of a full-capacity public emergency department at the main tertiary-level hospital in Tanzania

Abstract

BackgroundEmergency medicine is an emerging specialty in Sub-Saharan Africa, and most hospitals do not have a fully functional emergency department (ED). We describe the mortality rates of the Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania before and after the opening of a full-capacity ED.MethodsThis retrospective study investigated ED and hospital mortality rates for patients admitted to MNH from January 2008 to January 2012. This period represents 2 years before and 2 years after the opening of the full-capacity ED in January 2010. Trained abstractors analyzed patient care logbooks, attendance registers, nurse report books, and death certificates. The January 2008 to December 2009 data are from the limited-capacity casualty room (precursor of the ED), and for February 2010 to January 2012, they are from the new ED. Data are presented as proportions or differences with 95 % confidence intervals (CIs).ResultsDuring the 4-year study period, the number of visits increased from 53,660 (January 2008 to December 2009) in the casualty room to 77,164 (February 2010 to January 2012) in the new ED. During this time, the overall hospital mortality rate decreased from 13.6 % (95 % CI 13.3–13.9 %) in the January 2008 to December 2009 period to 8.2 % (95 % CI 8.0–8.3 %) in the February 2010 to January 2012 period. The corresponding casualty room and ED mortality rates were 0.34 % (95 % CI 0.25–0.35 %) and 0.74 % (95 % CI 0.68–0.80 %), respectively. In the casualty room, the most commonly reported cause of death was lower respiratory tract infection and least common was poisoning. In the new ED, the most commonly reported cause of death was congestive cardiac failure and the least common was cancer.ConclusionsThe opening of a full-capacity ED in a tertiary-level hospital in sub-Saharan Africa was associated with a significant decrease in hospital mortality. This is despite a small, but significant, increase in the mortality rate in the ED as compared to that in the casualty room that it replaced.

Diagnoses made in an Emergency Department in rural sub-Saharan Africa

“…This might reflect that the overall disease severity of hospitalised patients was higher as a result of improved triage, but also of a rise in hospital admission fees in 2016. These data stand in contrast to other studies, were in-hospital mortality rate decreased after implementation of a triaging system and emergency care in urban hospitals in sub-Saharan Africa [5][6][7][8]. Data about mortality in our study were retrospectively retrieved from register books from the wards, which might not have been completed properly.…”

“…Information on diagnoses made in emergency departments of hospitals in sub-Saharan Africa is scarce, and there are no reports on hospital mortality rates before and after implementing an emergency department in a rural hospital. However, the implementation of a triaging system and training of clinical staff in emergency care has been shown to be associated with a decrease of inhospital mortality rates in urban hospitals in Malawi, Sierra Leone and Tanzania [5][6][7][8]. During 1 year, we prospectively collated diagnoses of all patients presenting to the newly established emergency department in the St Francis Referral Hospital in Ifakara, Tanzania, and recorded inhospital mortality rates before and after the implementation of the emergency department.…”

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

“…1 2 6 There is increasing evidence for an emergency care system in LMIC as a public health strategy for secondary disease prevention as well as addressing the rapidly growing global burden of time-sensitive illnesses and acute injuries. 1–3 7 8 The limited availability of resources, however, is still a barrier to the development and implementation of emergency care systems in LMIC.…”

Subdissociative intranasal ketamine plus standard pain therapy versus standard pain therapy in the treatment of paediatric sickle cell disease vaso-occlusive crises in resource-limited settings: study protocol for a randomised controlled trial

“…Investigators from Carolinas Medical Center have a history of successful enrolment of MNH ED patients in several prior and ongoing investigations. [57][58][59][60][61] Our institution also has direct ties to MBH in Cameroon, where one of our study authors previously served as the chief of paediatrics. Current and former personnel from MBH have successfully collaborated on numerous national and international research investigations.…”