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Paediatric Emergency Triage, Assessment and Treatment (ETAT) - preparedness for implementation at primary care
Carina King1,2, Albert Dube3, Beatiwel Zadutsa4
1Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Frontline facilities in Malawi provide some emergency pediatric care, but face challenges in training and resources. Scaling up the WHO Emergency Triage Assessment and Treatment (ETAT) guidelines requires improved supply chains and referral systems.
Area of Science:
- Global Health
- Pediatric Emergency Medicine
- Health Systems Strengthening
Background:
- Preventable infectious diseases remain a leading cause of mortality in children under five.
- Weaknesses in emergency care and challenges with patient referrals significantly impact child survival rates.
Purpose of the Study:
- To assess the readiness of frontline health facilities in Malawi for implementing the World Health Organization's Emergency Triage Assessment and Treatment (ETAT) guidelines.
- To inform policy and planning for improved pediatric emergency care in Malawi.
Main Methods:
- A concurrent mixed-methods study involving facility audits, healthcare provider surveys, focus group discussions, and semi-structured interviews.
- Data collection occurred in Zomba and Mchinji districts, Malawi, encompassing dispensaries, primary health centers, and rural/community hospitals.
- Quantitative data were analyzed using descriptive statistics and regression, while qualitative data underwent framework analysis and triangulation.
Main Results:
- Triage practices were common, though varied; 53% of facilities reported all staff involved. Referral challenges were frequently cited, primarily due to transportation issues.
- Only 12% of healthcare providers had received ETAT training, with clinical officers reporting it more often. However, training was linked to increased knowledge across all cadres.
- Key barriers to ETAT implementation included resource limitations, while opportunities for quality improvement were identified.
Conclusions:
- Malawian frontline facilities demonstrate a foundational capacity for pediatric emergency care but require enhanced training, drug supplies, and equipment.
- Successful scale-up of ETAT necessitates policy interventions focusing on supply chain management, equipment maintenance, and robust referral communication systems.
Background:
The majority of deaths amongst children under 5 years are still due to preventable infectious causes. Emergency care has been identified as a key health system weakness, and referrals are often challenging.
Objective:
We aimed to establish how prepared frontline facilities in Malawi are to implement WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, to support policy and planning decisions.
Methods:
We conducted a concurrent mixed-methods study, including facility audit; healthcare provider survey; focus group discussions (FGD) and semi-structured interviews with facility staff. The study was conducted in two districts in Malawi, Zomba and Mchinji, between January and May 2019. We included all frontline facilities, including dispensaries, primary health centres, rural and community hospitals. Quantitative data were described using proportions, means and linear regression. Qualitative data was analysed using a framework approach. Data were analysed separately and then triangulated into common themes.
Results:
Forty-seven facilities and 531 healthcare providers were included in the audit and survey; 6 FGDs and 5 interviews were completed. Four common themes emerged: (1) current emergency case management; (2) referral practices; (3) trained staff capacity; (4) opportunities and barriers for ETAT. Triage was conducted in most facilities with various methods described, and 53% reporting all staff are responsible. Referrals were common, but challenging due to issues in transportation. Twelve percent of survey respondents had ETAT training, with clinical officers (41%) reporting this more frequently than other cadres. Training was associated with increased knowledge, independent of cadre. The main barriers to ETAT implementation were the lack of resources, but opportunities to improve quality of care were reported.
Conclusions:
Malawian frontline facilities are already providing a level of emergency paediatric care, but issues in training, drug supplies and equipment were present. To effectively scale-up ETAT, policies need to include supply chain management, maintenance and strengthening referral communication.
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