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Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388510/ https://www.ncbi.nlm.nih.gov/pubmed/25849960 http://dx.doi.org/10.1371/journal.pone.0122559 |
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author | Chamberlain, Stacey Stolz, Uwe Dreifuss, Bradley Nelson, Sara W. Hammerstedt, Heather Andinda, Jovita Maling, Samuel Bisanzo, Mark |
author_facet | Chamberlain, Stacey Stolz, Uwe Dreifuss, Bradley Nelson, Sara W. Hammerstedt, Heather Andinda, Jovita Maling, Samuel Bisanzo, Mark |
author_sort | Chamberlain, Stacey |
collection | PubMed |
description | BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS: Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS: Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION: This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening. |
format | Online Article Text |
id | pubmed-4388510 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-43885102015-04-21 Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes Chamberlain, Stacey Stolz, Uwe Dreifuss, Bradley Nelson, Sara W. Hammerstedt, Heather Andinda, Jovita Maling, Samuel Bisanzo, Mark PLoS One Research Article BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS: Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS: Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION: This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening. Public Library of Science 2015-04-07 /pmc/articles/PMC4388510/ /pubmed/25849960 http://dx.doi.org/10.1371/journal.pone.0122559 Text en © 2015 Chamberlain et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Chamberlain, Stacey Stolz, Uwe Dreifuss, Bradley Nelson, Sara W. Hammerstedt, Heather Andinda, Jovita Maling, Samuel Bisanzo, Mark Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title | Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title_full | Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title_fullStr | Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title_full_unstemmed | Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title_short | Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes |
title_sort | mortality related to acute illness and injury in rural uganda: task shifting to improve outcomes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388510/ https://www.ncbi.nlm.nih.gov/pubmed/25849960 http://dx.doi.org/10.1371/journal.pone.0122559 |
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