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A novel tool for assessing pediatric emergency care in low- and middle-income countries: a pilot study
Sonia Y Jarrett1, Andrew Redfern2, Joyce Li3
1Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. sonia.jarrett@childrens.harvard.edu.
Insights
A new tool pilots pediatric emergency care assessment in African hospitals. It highlights variations in resources and training, providing a baseline for improving pediatric emergency services in low- and middle-income countries.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Global Health
Background:
- Most children worldwide receive emergency care in general hospitals, not specialized pediatric units.
- Significant disparities exist in pediatric emergency care provision, especially in resource-limited settings.
- This study addresses the need for evaluating pediatric emergency care capabilities in low- and middle-income countries (LMICs) in Africa.
Purpose of the Study:
- To pilot a novel self-assessment tool for evaluating pediatric emergency care capabilities in LMIC hospitals.
- To assess key domains of pediatric emergency care, including triage, protocols, staffing, training, equipment, and medications.
Main Methods:
- A prospective, cross-sectional descriptive study was conducted in sub-Saharan African hospitals.
- An assessment tool was developed based on existing international standards and guidelines (WHO, IFEM).
- Data were collected from 16 hospitals across nine countries, analyzing pediatric emergency care domains using descriptive statistics.
Main Results:
- Sixteen hospitals participated, representing diverse regions and types (56.3% national/academic).
- Availability of dedicated pediatric triage (37.5%) and resuscitation spaces (56.3%) varied.
- Basic airway equipment was universal, but advanced equipment was present in only 37.5%; most WHO Essential Medicines were available.
Conclusions:
- This pilot introduces the first comprehensive pediatric emergency care assessment tool for LMICs.
- The study provides a foundational evaluation of pediatric emergency healthcare capabilities in African hospitals.
- Future work will refine the tool based on qualitative feedback to enhance its utility.
Background:
Globally, most children seek emergency care at general rather than specialized pediatric emergency departments. There remains significant variation in the provision of pediatric emergency care, particularly in resource-constrained settings. The objective of this study is to pilot a self-assessment tool to evaluate pediatric emergency care capabilities in low- and middle-income country (LMIC) hospitals on the African Continent.
Methods:
This was a prospective cross-sectional descriptive study using a convenience sample of sub-Saharan African hospitals. The assessment tool was developed by operationalizing the technical contents of existing standards and guidelines from international bodies including the World Health Organization and International Federation of Emergency Medicine. The pilot was conducted at emergency departments located across different regions on the African continent. Descriptive statistics were used to evaluate different domains of pediatric emergency care capabilities including pediatric triage, protocols, staffing, training, equipment, consumables, and medicines.
Results:
Sixteen hospitals with emergency departments completed the assessment tool (participation rate of 76%). The hospitals were in nine different countries across four regions of sub-Saharan Africa. National/academic hospitals comprised 56.3% of the participating hospitals. The majority, 44%, of these hospitals saw pediatric patient volumes of 2,000-4,999 patients per year. Dedicated pediatric triage spaces and resuscitation spaces were available at 37.5% and 56.3%, respectively. Formal pediatric resuscitation guidelines were used at 62.5%. Doctors on the self-assessment teams came from primarily pediatrics and general practitioner training backgrounds (both 68.8%). Basic respiratory and airway support equipment (e.g. oxygen, bag-valve mask devices) were available in all participating hospitals, whereas advanced airway equipment (e.g. pediatric intubation equipment) was available in 37.5% of hospitals. Most medicines from the World Health Organization Essential Medicines list were available at participating hospitals.
Conclusions:
To date, this is the first assessment tool dedicated to the comprehensive evaluation of pediatric emergency care in LMICs. This pilot provides a first approach to evaluate pediatric emergency healthcare capabilities in the hospital setting with future directions to improve the tool based on qualitative feedback.
