Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

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White Johansson, Emily,1976-Uppsala universitet,Internationell barnhälsa och nutrition (author)

Accessibility of basic paediatric emergency care in Malawi : analysis of a national facility census

Article/chapterEnglish2020

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2020-06-24
Springer Science and Business Media LLC,2020
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LIBRIS-ID:oai:DiVA.org:uu-420110
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-420110URI
https://doi.org/10.1186/s12889-020-09043-3DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:144072149URI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:art swepub-publicationtype

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BackgroundEmergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi's population distribution.MethodsWe analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google.ResultsFour (3.5, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4, 95% CI: 31.9-49.6), micro nebulizers (50.9, 95% CI: 41.9-60.0), and radiology (54.2, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67-77) ranging 1-507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%,p < 0.001).ConclusionsThere are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy hsv//eng
Malawi
Emergency care
Paediatrics
Health systems

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Lindsjö, CeciliaKarolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy Res Grp, SE-17177 Stockholm, Sweden (author)
Weiss, Daniel J.Univ Oxford, Nuffield Dept Med, Li Ka Shing Ctr Hlth Informat & Discovery, Oxford Big Data Inst, Oxford OX3 7LF, England (author)
Nsona, HumphreysMinist Hlth, Integrated Management Childhood Illness IMCI Unit, Lilongwe, Malawi (author)
Ekholm Selling, Katarina,1976-Uppsala universitet,Internationell barnhälsa och nutrition(Swepub:uu)katse272 (author)
Lufesi, NormanMinist Hlth, Community Hlth Sci Unit, Lilongwe, Malawi (author)
Hildenwall, HelenaKarolinska Institutet (author)
Uppsala universitetInternationell barnhälsa och nutrition (creator_code:org_t)

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In:BMC Public Health: Springer Science and Business Media LLC20:11471-2458

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