Abstract:
BACKGROUND: Information on diagnoses made in emergency
departments situated in rural sub-Saharan Africa is
scarce. The aim was: to evaluate the frequency of different
diagnoses made in a new emergency department to
define relevant healthcare requirements; and to find out if
in-hospital mortality rates would decrease after the implementation
of the emergency department.
METHODS: In this observational study, we prospectively
collated diagnoses of all patients presenting to the emergency
department of the St Francis Referral Hospital in
Ifakara, Tanzania during 1 year. In addition, we compared
in-hospital mortality rates before and after the implementation
of the emergency department.
RESULTS: From July 2016 through to June 2017, a total
of 35,903 patients were included. The median age was
33.6 years (range 1 day to 100 years), 57% were female,
25% were children <5 years, 4% were pregnant and 9%
were hospitalised. The most common diagnoses were respiratory
tract infection (12.6%), urinary tract infection
(11.4%), trauma (9.8%), undifferentiated febrile illness
(5.4%), and malaria (5.2%). The most common clinical diagnoses
per age group were: lower respiratory tract infection
(16.1%) in children <5 years old; trauma (21.6%)
in 5- to 17-year-olds; urinary tract infection (13.5%) in
18- to 50-year-olds; and hypertensive emergency (12.4%)
in >50-year-olds. Respiratory tract infections peaked in
April during the rainy season, whereas malaria peaked 3
months after the rainy season. In-hospital mortality rates
did not decrease during the study period (5.6% in 2015 vs
7.6% in 2017).
CONCLUSIONS: The majority of diagnosed disorders
were of infectious or traumatic origin. The majority of
febrile illnesses were poorly defined because of the lack of
diagnostic methods. Trauma systems and inexpensive accurate
diagnostic methods for febrile illnesses are needed
in rural sub-Saharan Africa.
