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Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Published online by Cambridge University Press:  15 November 2018

Sunkaru Touray Open the ORCID record for Sunkaru Touray [Opens in a new window] ,
Baboucarr Sanyang ,
Gregory Zandrow  and
Isatou Touray
Sunkaru Touray*
Affiliation:
University of New Mexico School of Medicine, Albuquerque, New MexicoUSA University of Massachusetts Medical School, Worcester, MassachusettsUSA
Baboucarr Sanyang
Affiliation:
Serekunda General Hospital, Ministry of Health & Social Welfare, Gambia
Gregory Zandrow
Affiliation:
University of Massachusetts Medical School, Worcester, MassachusettsUSA
Isatou Touray
Affiliation:
Ministry of Health & Social Welfare, Republic of Gambia
*
Correspondence: Sunkaru Touray, MB, ChB, MSc Assistant Professor of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico USA E-mail: [email protected]
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Abstract

Background

The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.

Problem

Data on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.

Methods

A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.

Results

Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.

Conclusion

: There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country.

TourayS, SanyangB, ZandrowG, TourayI. Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care. Prehosp Disaster Med. 2018;33(6):650–657.

Keywords

acute medical emergenciesGambiahealth insurancelow- and middle-income countriesmortalitytravel time
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 6 , December 2018 , pp. 650 - 657
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflict of interest: The authors have no conflicts of interest with regard to the content of this manuscript.

References

1. Haagsma, JA, Graetz, N, Bolliger, I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016;22(1):3-18.Google Scholar
2. McCord, C, Ozgediz, D, Beard, JH, et al. “General Surgical Emergencies.” In: Debas HT, Donkor P, Gawande A, et al, (eds). Essential Surgery: Disease Control Priorities. Third Edition (Volume 1). Washington, DC USA: The International Bank for Reconstruction and Development/The World Bank, 2015.Google Scholar
3. Jasseh, M, Howie, SRC, Gomez, P, et al. Disease-specific mortality burdens in a rural Gambian population using verbal autopsy, 1998–2007. Glob Health Action. 2014;7:25598.Google Scholar
4. Health Management Information System: Health Information Service Statistics Report. Banjul, The Gambia, Ministry of Health and Social Welfare, 2016.Google Scholar
5. Pinder, M, Jawara, M, Jarju, LBS, et al. Efficacy of indoor residual spraying with dichlorodiphenyltrichloroethane against malaria in Gambian communities with high usage of long-lasting insecticidal mosquito nets: a cluster-randomized controlled trial. Lancet. 2015;385(9976):1436-1446.Google Scholar
6. D’Alessandro, U, Hill, J, Tarning, J, et al. Treatment of uncomplicated and severe malaria during pregnancy. Lancet Infect Dis. 2018;18(4):e133-146.Google Scholar
7. Adegbola, RA, Secka, O, Lahai, G, et al. Elimination of Hemophilus influenzae type b (Hib) disease from The Gambia after the introduction of routine immunization with a Hib conjugate vaccine: a prospective study. Lancet. 2005;366(9480):144-150.Google Scholar
8. Viviani, S, Jack, A, Hall, AJ, et al. Hepatitis B vaccination in infancy in The Gambia: protection against carriage at 9 years of age. Vaccine. 1999;17(23–24):2946-2950.Google Scholar
9. Adetifa, IM, Kendall, L, Bashorun, A, et al. A tuberculosis nation-wide prevalence survey in Gambia, 2012. Bull World Health Organ. 2016;94(6):433-441.Google Scholar
10. Ministry of Health and Social Welfare. THE GAMBIA HEALTH POLICY: “HEALTH IS WEALTH.” 2011–2015.Google Scholar
11. Ikem, I, Sumpio, BE. Cardiovascular disease: the new epidemic in sub-Saharan Africa. Vascular. 2011;19(6):301-307.Google Scholar
12. Temu, F, Leonhardt, M, Carter, J, et al. Integration of non-communicable diseases in health care: tackling the double burden of disease in African settings. Pan Afr Med J. 2014;05;18(202).Google Scholar
13. Omoleke, SA. Chronic non-communicable disease as a new epidemic in Africa: focus on The Gambia. Pan Afr Med J. 2013;14(87).Google Scholar
14. World Bank. The World Bank in The Gambia. Overview. http://www.worldbank.org/en/country/gambia/overview. Accessed May 28, 2018.Google Scholar
15. The Gambia Bureau of Statistics: The Gambia 2013 Population and Housing Census Preliminary Results. Serekunda, The Gambia; 2013.Google Scholar
16. Mould-Millman, N-K, Rominski, SD, Bogus, J, et al. Barriers to accessing Emergency Medical Services in Accra, Ghana: development of a survey instrument and initial application in Ghana. Glob Health Sci Pract. 2015;3(4):577-590.Google Scholar
17. Gambia Bureau of Statistics. National Disability Survey. The Gambia, 1998.Google Scholar
18. Gambia Bureau of Statistics. The Gambia Demographic and Health Survey. Banjul, The Gambia, 2013.Google Scholar
19. Thaddeus, S, Maine, D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091-1110.Google Scholar
20. Donkor, ES, Owolabi, MO, Bampoh, P, et al. Community awareness of stroke in Accra, Ghana. BMC Public Health. 2014;14:196.Google Scholar
21. Komolafe, MA, Obembe, AO, Olaogun, MO, et al. Awareness of stroke risk factors and warning signs in Nigerian adolescents compared with adults. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2015;24(3):687-693.Google Scholar
22. Kakou-Guikahue, M, N’Guetta, R, Anzouan-Kacou, J-B, et al. Optimizing the management of acute coronary syndromes in sub-Saharan Africa: a statement from the AFRICARDIO 2015 Consensus Team. Arch Cardiovasc Dis. 2016;109(6–7):376-383.Google Scholar
23. Stern, EB, Berman, M, Thomas, JJ, et al. Community education for stroke awareness: an efficacy study. Stroke. 1999;30(4):720-723.Google Scholar
24. Tedim Cruz, V, Araújo, I, Alves, I, et al. Freeze the stroke: public awareness program for immediate detection of first symptoms. Stroke. 2012;43(9):2510-2512.Google Scholar
25. Gummi, FB, Hassan, M, Shehu, D, et al. Community education to encourage use of emergency obstetric services, Kebbi State, Nigeria. The Sokoto PMM Team. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1997;59(Suppl 2):S191-200.Google Scholar
26. Opoku, SA, Kyei-Faried, S, Twum, S, et al. Community education to improve utilization of emergency obstetric services in Ghana. The Kumasi PMM Team. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1997;59(Suppl 2):S201-207.Google Scholar
27. Ogwang, S, Najjemba, R, Tumwesigye, NM, et al. Community involvement in obstetric emergency management in rural areas: a case of Rukungiri district, Western Uganda. BMC Pregnancy Childbirth. 2012;12:20.Google Scholar
28. Wright, RS, Kopecky, SL, Timm, M, et al. Impact of community-based education on health care evaluation in patients with acute chest pain syndromes: the Wabasha Heart Attack Team (WHAT) project. Fam Pract. 2001;18(5):537-539.Google Scholar
29. Bryant-Stephens, T, Li, Y. Community asthma education program for parents of urban asthmatic children. J Natl Med Assoc. 2004;96(7):954-960.Google Scholar
30. Cham, M, Sundby, J, Vangen, S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005;2:3.Google Scholar
31. Gomez, D, Berube, M, Xiong, W, et al. Identifying targets for potential interventions to reduce rural trauma deaths: a population-based analysis. J Trauma. 2010;69(3):633-639.Google Scholar
32. Bitter, CC, Rice, B, Periyanayagam, U, et al. What resources are used in emergency departments in rural sub-Saharan Africa? A retrospective analysis of patient care in a district-level hospital in Uganda. BMJ Open. 2018;24;8(2):e019024.Google Scholar
33. Stolz, LA, Muruganandan, KM, Bisanzo, MC, et al. Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Trop Med Int Health TM IH. 2015;20(8):1067-1072.Google Scholar
34. Chamberlain, S, Stolz, U, Dreifuss, B, et al. Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes. PloS One. 2015;10(4):e0122559.Google Scholar
35. Dresser, C, Periyanayagam, U, Dreifuss, B, et al. Management and outcomes of acute surgical patients at a district hospital in Uganda with non-physician emergency clinicians. World J Surg. 2017;41(9):2193-2199.Google Scholar
36. Bergström, S, McPake, B, Pereira, C, et al. “Workforce Innovations to Expand the Capacity for Surgical Services.” In: Debas HT, Donkor P, Gawande A, et al, (eds). Essential Surgery: Disease Control Priorities. Third Edition (Volume 1). Washington, DC USA: The International Bank for Reconstruction and Development/The World Bank, 2015.Google Scholar
37. Stafford, RE, Morrison, CA, Godfrey, G, et al. Challenges to the provision of emergency services and critical care in resource-constrained settings. Glob Heart. 2014;9(3):319-323.Google Scholar
38. Nafissi, N, Saghafinia, M, Balochi, K. Improving trauma care in rural Iran by training existing treatment chains. Rural Remote Health. 2008;8(4):881.Google Scholar
39. Marsh, RH, Rouhani, SA. Gaps in physical access to emergency care in sub-Saharan Africa. Lancet Glob Health. 2018;6(3):e240-241.Google Scholar
40. Cham, M, Sundby, J, Vangen, S. Availability and quality of emergency obstetric care in Gambia’s main referral hospital: women-users’ testimonies. Reprod Health. 2009;6:5.Google Scholar
41. Telfer, ML, Rowley, JT, Walraven, GEL. Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health. 2002;6(1):74-83.Google Scholar
42. Ouma, PO, Maina, J, Thuranira, PN, et al. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Glob Health. 2018;6(3):e342-350.Google Scholar
43. Razzak, JA, Kellermann, AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002;80(11):900-905.Google Scholar
44. Sodemann, M, Jakobsen, MS, Mølbak, K, et al. High mortality despite good care-seeking behavior: a community study of childhood deaths in Guinea-Bissau. Bull World Health Organ. 1997;75(3):205-212.Google Scholar
45. Kironji, AG, Hodkinson, P, Ramirez, SS de, et al. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC Health Serv Res. 2018;18.Google Scholar
46. Touray, S, Sanyang, B, Zandrow, G, et al. An assessment of critical care capacity in The Gambia. J Crit Care. 2018;47:245-253.Google Scholar
47. Gambia Bureau of Statistics. Integrated Household Survey Income and Expenditure Poverty Assessment. Government of The Gambia, 2011.Google Scholar
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