An Analysis of the Clinical Practice of Emergency Medicine in Public District and Regional Hospitals in Tanzania

Mbaya, Khalid Rajabu (2013-03)

Thesis

Aim: The aim of the study was to document the burden of disease presenting to Tanzania mainland public district and regional hospitals’ acute intake areas, to describe the range of early diagnostic and procedural interventions performed on acutely ill patients, and to identify the disposition of these patients. Method: We undertook a cross-sectional, prospective study which described the clinical presentation, investigations, procedures and diagnoses of patients presented to public district and regional hospitals in Tanzania. A consecutive convenience sample of patients presenting during the working hours site visit to each hospital were included for those hospitals only open during the day. For hospitals which open for 24 hours, a 12 hour day time visiting period was selected. Results: District hospitals saw 60% of patients, designated district hospitals 16% and regional hospitals 24%. There was no 24 hours functioning acute intake area with a dedicated doctor for such areas in 70% of regional hospitals, 88% of designated district hospitals and 98% of district hospitals. The gender distribution of male to female was 1:1.3. Infants and geriatric patients accounted for 38%, adolescences and adults 50%, children of school age 12%; average work load was 50 patients per day shift. Medical-Surgical cases were 92% of cases, and the rest were trauma. The three most common complaints were fever, cough and abdominal pains. MVA was the leading cause of trauma. Blood test, X-ray, urinalysis, and stool analysis were the most common investigations. Wound care, fracture reduction, Incision and drainage were the commonest procedures performed. Malaria, respiratory infections and genito-urinary diseases were the leading causes of morbidity. 23% of cases ended up admitted for workup, treatment and senior doctor’s consultation, with only 1% of patients referred to higher level hospitals. Conclusion: The study revealed that almost no public hospitals had any form of emergency care system in place; most emergency patients are seen undifferentiated in OPDs. Infectious diseases and trauma are the leading cause of morbidity; investigations and treatments are based specifically on treating the cause, with no consideration on treating the complications of these diseases. Urgent work is required to establish hospital-based emergency care systems in Tanzania.

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