Sub-Saharan African Journal of Medicine

EDITORIAL COMMENT
Year
: 2017  |  Volume : 4  |  Issue : 1  |  Page : 1--2

Emergency pediatric care in resource-constrained settings


Gboye Olufemi Ogunrinde 
 Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria

Correspondence Address:
Gboye Olufemi Ogunrinde
Department of Paediatrics, Ahmadu Bello University, Zaria
Nigeria




How to cite this article:
Ogunrinde GO. Emergency pediatric care in resource-constrained settings.Sub-Saharan Afr J Med 2017;4:1-2


How to cite this URL:
Ogunrinde GO. Emergency pediatric care in resource-constrained settings. Sub-Saharan Afr J Med [serial online] 2017 [cited 2022 Dec 9 ];4:1-2
Available from: https://www.ssajm.org/text.asp?2017/4/1/1/226662


Full Text

There is no gainsaying that the future of a nation, bright or mortgaged, depends to a significant extent on the quality of children “produced” in the present day. Children in any society constitute the most vulnerable group. Their very nature makes them prone to accidents, injuries, and illnesses, many of which threaten the life and/or quality of life. As a result of their incompletely developed immune system, children under 5 years are particularly prone to severe malaria, a clinical condition that still accounts for significant mortality in African settings.[1] Over 60% of otorhinolaryngology emergencies in a teaching hospital emergency room were in children aged a few months to 15 years.[2] The number of children in emergency situations has increased exponentially in conflict-riddled African nations.[3],[4] Most deaths in resource-constrained setting arise from preventable and reversible causes.[5] It, therefore, becomes imperative that the emergency care of children be well developed and finely tuned in developing countries such as Nigeria.[6]

Many pediatric emergency units in low- and middle-income countries are currently being manned by doctors with no subspecialty training in pediatric emergency.[6] It is a common practice to find resident doctors running a children emergency room under the supervision of a consultant pediatrician who has no subspecialty pediatric emergency care training. It is unlikely to find a greater proportion of pediatricians or other specialties or general practitioners being able to intubate a critically injured or sick child. This is despite the fundamentals of resuscitation emphasizing airway maintenance and breathing as first critical steps in the emergency care of children.

There appears to be a maldistribution of pediatric emergency unit in the nation, with most being in the urban centers.[6] Emergency departments are described as overcrowded.[7]

Equipments in pediatric emergency units are mostly outdated, broken down, or under-utilized for various reasons. Most of the time, essential equipment is simply not available and frequently not affordable to the end-users.

The results of the aforementioned are poor outcomes from our emergency units, in terms of mortality, morbidity, return visits to the emergency units, and national economic losses when parents extend their stays in these units.[8] The poor outcome in some emergency pediatric units has been blamed on late patient presentation.[8] A 10.1% mortality rate was reported in children admitted into an emergency room, over 1 year, for non-trauma surgical abdominal emergencies.[9] Mortality in this study was mostly in newborns (11/13). Other mortality-related factors were late presentation and the development of complications.

There is a need to bolster the situation. Education and training of different cadres of hospital staff in pediatric emergency care should ensure more optimal outcome with a bright prospect for the children as they grow into adults. Studies have reported a significant proportion of mortality occurring early during admission, thus, indicating the need to improve pediatric emergency care.[10] There is a need to promote research capabilities in these units, in terms of personnel development, upgraded laboratory equipment, and infrastructure. Many guidelines, including the recently developed International Surviving Sepsis Campaign guidelines 2016, are not focused on issues and situations in low- and middle-income countries.[11]

There would have to be a committed approach to the funding of pediatric emergency units. In some countries, this is the responsibility of the federal or central government. However, there is a need to promote the participation of all relevant stakeholders. The national health insurance scheme in Nigeria would need to be overhauled, cleaned up, streamlined, and transparently focused on the wellbeing of the end-users.

Regular monitoring and possible accreditation of pediatric emergency rooms and units by relevant regulatory authorities (e.g., the Medical and Dental Council of Nigeria) should be instituted to maintain and improve standards across the nation.

References

1Iloh G, Ofoedu J, Njoku P, Amadi A, Godswill-Uko E. The magnitude of under-five emergencies in a resource-poor environment of a rural hospital in eastern Nigeria: Implication for strengthening the Household and Community-Integrated Management of Childhood Illness. N Am J Med Sci 2012;4:344-9.
2Adoga A, Okwori E, Yaro J, Iduh A. Pediatric otorhinolaryngology emergencies at the Jos University Teaching Hospital: Study of frequency, management and outcomes. Ann Afr Med 2017;16:81-4.
3Coghlan B, Brennan R, Ngoy P, Dofara D, Otto B, Clements M et al. Mortality in the Democratic Republic of Congo: A nationwide survey. Lancet 2006;367:44-51.
4Obi F, Eboreime E. The Conversation. [Online]; 2017. Available from: http://theconversation.com/how-boko-haram-is-devastating-health-services-in-north-east-nigeria-65751. [Last accessed on 2018 Jan 13].
5Turner E, Nielsen K, Jamal S, von Saint Andre-von Arnim A, Musa N. A review of pediatric critical care in resource-limited settings: A look at past, present, and future directions. Front Pediatr 2016;4:5.
6Obermeyer Z, Abujaber S, Makar M, Stoll S, Kayden S. Emergency care in 59 low- and middle-income countries: A systematic review. Bull World Health Organ 2015;93:577-86.
7Makama J, Iribhogbe P, Ameh E. Overcrowding of accident and emergency units: Is it a growing concern in Nigeria? Afr Health Sci 2015;15:457-65.
8Ndukwu C, Onah S. Pattern and outcome of postneonatal pediatric emergencies in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South East Nigeria. Niger J Clin Pract 2015;18:348-53.
9Ademuyiwa A, Bode C, Adesanya O, Elebute A. Non-trauma related paediatric abdominal surgical emergencies in Lagos, Nigeria: Epidemiology and indicators of survival. Niger Med J 2012;53:76-9.
10Bohn J, Kassaye B, Record D, Chou B, Kraft I, Purdy J et al. Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia. BMC Pediatr 2016;16:168.
11Shrestha G, Kwizera A, Lundeg G, Baelani J, Azevedo L, Pattnaik R. International Surviving Sepsis Campaign guidelines 2016: The perspective from low-income and middle-income countries. Lancet Infect Dis 2017;17:893-5.