Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.
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.
Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs.
Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC). Spatial travel-time analyses provide a visualization of changes in timely access.
Timely access to emergency obstetric care is crucial in preventing mortalities associated with
pregnancy and childbirth. The referral of patients from lower levels of care to higher levels has been identified as
an integral component of the health care delivery system in Ghana. To this effect, in 2012, the National Referral
Policy and Guidelines was developed by the Ministry of Health (MOH) to help improve standard procedures and
reduce delays which affect access to emergency care. Nonetheless, ensuring timely access to care during referral of
obstetric emergencies has been problematic. The study aimed to identify barriers associated with the referral of
emergency obstetric cases to the leading national referral centre. It specifically examines the lived experiences of
patients, healthcare providers and relatives of patients on the referral system.
The African continent is predicted to be home to over half of the expected global population growth between
2015 and 2050, highlighting the importance of addressing population health in Africa for improving public health
globally. By 2050, nearly 60% of the population of the continent is expected to be living in urban areas and 35–
40% of children and adolescents globally are projected to be living in Africa. Urgent attention is therefore required
to respond to this population growth - particularly in the context of an increasingly urban and young population.
To this end, the Research Initiative for Cities Health and Equity in Africa (RICHE Africa) Network aims to support the
development of evidence to inform policy and programming to improve urban health across the continent. This
paper highlights the importance of action in the African continent for achieving global public health targets.
Despite an estimated one billion people around the world living in slums, most surveys of health and well-being do not distinguish between slum and non-slum urban residents. Identifying people who live in slums is important for research purposes and also to enable policymakers, programme managers, donors and non-governmental organisations to better target investments and services to areas of greatest deprivation. However, there is no consensus on what a slum is let alone how slums can be distinguished from non-slum urban precincts. Nor has attention been given to a more fine-grained classification of urban spaces that might go beyond a simple slum/non-slum dichotomy. The purpose of this paper is to provide a conceptual framework to help tackle the related issues of slum definition and classification of the urban landscape.
In many low and middle-income countries (LMICs), timely access to emergency healthcare services
is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays
for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in
Nairobi, Kenya, one of the largest and most congested cities in the developing world.
Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83–100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.
Annually, 303,000 women die from pregnancy-related complications, and almost all of them occur in developing countries, particularly in Africa and Asia. Approximately 60% of the maternal deaths are due to sepsis, hemorrhage, hypertensive disorders, obstructed labor, and unsafe abortion. In addition, for each woman who dies as the direct or indirect result of pregnancy, a significantly higher number experience a life-threatening complication that will require attention of skilled obstetric caregivers to prevent morbidity and mortality. Nearly 10% of mothers suffer a maternal complication during pregnancy or in the intra-partum period, and up to 40% may have morbidities post-birth that are attributable to the pregnancy or birth. Most of these complications are treatable and preventable during antenatal care (ANC) and if births are overseen by skilled birth attendants. Furthermore, neonatal and maternal mortality and morbidity are closely linked. About one-third of neonatal deaths occur during the first twenty-four hours of birth.