Analysis of the resources for emergency care in district and regional public hospitals in Tanzania
Thesis (MMed)--Stellenbosch University, 2013.
ENGLISH SUMMARY : Introduction: As a new speciality in many African countries, Emergency Medicine in Tanzania was recognised in 2011. The aim of the study was to analyse the resources available for emergency care in public hospitals’ acute intake areas by evaluating the equipment, human resource (availability and composition) and supportive (radiological and laboratory) services. Methods: The study was a prospective, cross-sectional design covering 98% of regional and district hospitals, both as first referral point from primary health facilities i.e. dispensaries and health centres. We directly inspected facilities and equipment and employed a structured checklist adopted from the Emergency Medicine Society of South Africa (EMSSA) to capture the data. The investigator also interviewed both the head of the acute intake area/Medical Officer In Charge while the staff working in the area was visited to check the accuracy of the data collection, as well as to provide details on the staffing composition. Results: Among the hospitals surveyed, there was a deficit of human resources, equipment and medications for resuscitating and stabilising acutely ill patients. An oxygen supply was present in 30% of cases while a bag valve mask was found in only 18% of cases. There was no nebuliser or set of equipment for intubation or ventilation. A working pulse oxymeter was observed in 20% of the hospitals, cardiac monitoring was possible in 3% and none had a defibrillator. Amiadorone was available in 4% of the hospitals, potassium chloride in 9% and Verapamil was present in only 7%. An x-ray service was absent in 37% of hospitals; in 25% the reason given was ‘waiting for repair’ and there was not a single CT-scanner among the hospitals. While the main service providers in acute intake areas were the least qualified health personnel (clinical officer in 99% and health attendant in 99%), only 10% of the acute intake areas had access to consultant from any specialty . Conclusion: The study identified deficits in equipment and human resources quality and quantity across regional and district hospitals in Tanzania. A shortage of supplies, misallocation of the resources, a long awaiting repair time and inadequate training in life support skills partly contributed to the deficit observed.
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