Paediatric emergencies in sub-Saharan Africa
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Date
2017-12
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African Journal of Emergency Medicine
Abstract
Every health worker who cares for children has to deal with medical emergencies. They are common and can start with alarming rapidity, yet if treated quickly and effectively will often have a good, or at least better than expected outcome. No one can deny the importance of medical emergencies, yet many health workers who need to manage emergencies do not have access to the necessary training. Some are working in isolation, in remote facilities and without equipment conducive to excellent care. In most district hospitals, emergency medicine, outpatients and immunisation clinics are combined and run by the same staff. In a survey of African emergency care, Obermeyer, et al. found that of 192 facilities only 11 (6%) were in rural areas and only 36 (19%) were designated for children.1
A great deal of effort has gone into improving the situation; for example interactive, scenario-based courses such as ETAT (Emergency Triage Assessment and Treatment) and ETAT+, teach emergency care over a 5-day period.2., 3. Despite this many health workers do not have access to the training and practice that they need and desire. The situation is not helped by the frequent transfer between departments of health staff in many public hospitals.
In 2013 a one-day African consensus conference was held in Cape Town to determine what ‘signal’ conditions an emergency centre should be able to manage. Signal conditions were defined as shock, respiratory failure, dangerous fevers, altered consciousness, severe pain, trauma and burns. All of these conditions are potentially life threatening and managing them requires infrastructure, equipment, consumables, laboratory service support and trained staff. Lists of what are required to manage each condition are categorised as essential or desirable.4 All of these conditions are important in children but health workers caring for children also need to be alert to possible maltreatment.
Good outcomes depend on doing the right thing at the right time, every time. This requires not only know-how, but also having the right tools (equipment, drugs), space and staff who work efficiently and well. Medical successes come with teamwork, multi-tasking, mutual respect, clear guidelines and pride in each other’s skills. Parents and guardians are our strongest allies and their acceptance and cooperation is essential. Their trust and dignity in the face of possible disaster is humbling.
This special issue of the African Journal of Emergency Medicine, include a resource-tiered review of five paediatric emergencies along with a systematic review and meta-analysis comparing weight guestimates instruments. The authors all work in Africa and have extensive practical experience in the topics they review. Topics covered are the management of respiratory support, shock, acute convulsions, burns and child abuse. The aim is to be practical, applicable and evidence based. By sharing their experience with us they expand our horizons, demonstrate best practice and give options for care.
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Keywords
Paediatric, Paediatric emergencies, Africa