Sarah Stewart de Ramirez

Health systems and services: the role of acute care

As populations continue to grow and age, there will be increasing demand for acute curative services responsive to life-threatening emergencies, acute exacerba -tion of chronic illnesses and many routine health problems that nevertheless require prompt action. Emergency interven-tions and services should be integrated with primary care and public health measures to complete and strengthen health systems. This paper focuses on acute care within that context. First, we draw on standard World Health Organi -zation (WHO) terminology to propose working terms to define “acute care”. Second, we highlight the fragmentation of service delivery that results from not adopting the proposed definition. Third, we show the potential contribution of acute care to integrated health systems designed to reduce all-cause morbidity and mortality. Finally, we propose key steps to further the development of acute care that leaders, researchers and health workers, who are the people responsible for maintaining strong national health systems, should consider taking.

Unintentional injuries: magnitude, prevention, and control.

The World Health Organization estimates injuries accounted for more than 5 million deaths in 2004, significantly impacting the global burden of disease. Nearly 3.9 million of these deaths were due to unintentional injury, a cause also responsible for more than 138 million disability-adjusted life years (DALYs) lost in the same year. More than 90% of the DALYs lost occur in low- and middle-income countries (LMICs), highlighting the disproportionate burden that injuries place on developing countries. This article examines the health and social impact of injury, injury data availability, and injury prevention interventions. By proposing initiatives to minimize the magnitude of death and disability due to unintentional injuries, particularly in LMICs, this review serves as a call to action for further investment in injury surveillance, prevention interventions, and health systems strengthening.

Risk factors for non‐communicable diseases among older adults in rural Africa

Objective  To expand the evidence base on the prevalence of non‐communicable disease (NCD) risk factors in rural Africa, in particular among older adults aged 50 and older.

Emergency response in resource-poor settings: a review of a newly-implemented EMS system in rural Uganda.

INTRODUCTION The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries. Problem The objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda. METHODS An EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed. RESULTS In total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of

Home injury risks to young children in Karachi, Pakistan: a pilot study

89.95 per life saved with an estimated

Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessments in Pakistan

0.93/capita to establish the system and

Including emergency and acute care as a global health priority

0.09/capita/year to maintain the system. CONCLUSION Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.

Disseminating Childhood Home Injury Risk Reduction Information in Pakistan: Results from a Community-Based Pilot Study

Objective To pilot an in-home unintentional injury hazard assessment tool and to quantify potential injury risks for young children in a low-income urban setting. Methods Two low-income neighbourhoods in Karachi, Pakistan, were mapped, and families with at least one child between the ages of 12 and 59 months were identified. Using existing available home injury risk information, an in-home injury risk assessment tool was drafted and tailored to the local setting. Home injury assessments were done in June–July 2010 after obtaining informed consent. Results Approximately 75.4% of mothers were educated through at least grade 12. The main risks identified were stoves within the reach of the child (n=279, 55.5%), presence of open buckets in the bathroom (n=240, 47.7%) within the reach of the child, and pedestal fans accessible to the child (n=242, 48.1%). In terms of safety equipment, a first-aid box with any basic item was present in 70% of households, but only 4.8% of households had a fire extinguisher in the kitchen. Conclusions This was the first time that an in-home, all-unintentional injury risk assessment tool was tailored and applied in the context of a low-income community in Pakistan. There was a significant burden of hazards present in the homes in these communities, representing an important opportunity for injury prevention. This pilot may have future relevance to other LMICs where child injury prevention is a critical need.

Defining and improving the role of emergency medical services in Cape Town, South Africa

Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.

Nursing Perceptions of the Emergency Severity Index as a Triage Tool in the United Arab Emirates: A Qualitative Analysis

A recent important global meeting to set the international action agenda concerning non-communicable diseases (NCDs) failed to draw substantial attention from the emergency medical and surgical community. Advocacy efforts on the part of emergency clinicians should be increased to highlight the critical services we provide and create an approach to addressing NCDs with the most effective balance of preventive and acute care services. Acute care, which encompasses all frontline treatment services for sudden or unexpected injury or illness, can serve as a focal point for the development of the common language and body of research needed to draw the attention of global leaders and policy makers.