Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes

PLoS One. 2015 Apr 7;10(4):e0122559. doi: 10.1371/journal.pone.0122559. eCollection 2015.

Abstract

Background: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients.

Methods: Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit.

Findings: Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives.

Interpretation: This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / mortality*
  • Acute Disease / therapy
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Quality Assurance, Health Care
  • Retrospective Studies
  • Rural Population / statistics & numerical data*
  • Treatment Outcome
  • Uganda
  • Young Adult

Grants and funding

Global Emergency Care Collaborative (GECC) is a non-profit charitable organization registered in the United States and Uganda, which is funded through private non-corporate, non-governmental donations. GECC was responsible for providing partial salary support for the Emergency Care Practitioners who were the health professionals who cared for emergency patients in this study. Additionally, GECC paid stipends for volunteer research assistants and an onsite Program Director. None of the authors of this study have received any financial compensation for activities related to this study.