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

Stacey Chamberlain, Uwe Stolz, Bradley Dreifuss, Sara W. Nelson, Heather Hammerstedt, Jovita Andinda, Samuel Maling, Mark Bisanzo

Research output: Contribution to journalArticle

16 Citations (Scopus)

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) 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. was 6.5% overall and 6.8% for under-fives.

Original languageEnglish (US)
Article numbere122559
JournalPLoS One
Volume10
Issue number4
DOIs
StatePublished - Apr 7 2015

Fingerprint

Uganda
Mortality
Wounds and Injuries
Emergency Medical Services
Quality assurance
Malnutrition
Malaria
Hospital Emergency Service
Pneumonia
education programs
Emergencies
malnutrition
malaria
pneumonia
Health
Education
Rural Hospitals
District Hospitals
nurses
health care workers

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Chamberlain, S., Stolz, U., Dreifuss, B., Nelson, S. W., Hammerstedt, H., Andinda, J., ... Bisanzo, M. (2015). Mortality related to acute illness and injury in rural Uganda: Task shifting to improve outcomes. PLoS One, 10(4), [e122559]. https://doi.org/10.1371/journal.pone.0122559

Mortality related to acute illness and injury in rural Uganda : Task shifting to improve outcomes. / Chamberlain, Stacey; Stolz, Uwe; Dreifuss, Bradley; Nelson, Sara W.; Hammerstedt, Heather; Andinda, Jovita; Maling, Samuel; Bisanzo, Mark.

In: PLoS One, Vol. 10, No. 4, e122559, 07.04.2015.

Research output: Contribution to journalArticle

Chamberlain, S, Stolz, U, Dreifuss, B, Nelson, SW, Hammerstedt, H, Andinda, J, Maling, S & Bisanzo, M 2015, 'Mortality related to acute illness and injury in rural Uganda: Task shifting to improve outcomes', PLoS One, vol. 10, no. 4, e122559. https://doi.org/10.1371/journal.pone.0122559
Chamberlain, Stacey ; Stolz, Uwe ; Dreifuss, Bradley ; Nelson, Sara W. ; Hammerstedt, Heather ; Andinda, Jovita ; Maling, Samuel ; Bisanzo, Mark. / Mortality related to acute illness and injury in rural Uganda : Task shifting to improve outcomes. In: PLoS One. 2015 ; Vol. 10, No. 4.
@article{2e0103fccb2c4026b833c54c126bf0de,
title = "Mortality related to acute illness and injury in rural Uganda: Task shifting to improve outcomes",
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) 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. was 6.5{\%} overall and 6.8{\%} for under-fives.",
author = "Stacey Chamberlain and Uwe Stolz and Bradley Dreifuss and Nelson, {Sara W.} and Heather Hammerstedt and Jovita Andinda and Samuel Maling and Mark Bisanzo",
year = "2015",
month = "4",
day = "7",
doi = "10.1371/journal.pone.0122559",
language = "English (US)",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "4",

}

TY - JOUR

T1 - Mortality related to acute illness and injury in rural Uganda

T2 - Task shifting to improve outcomes

AU - Chamberlain, Stacey

AU - Stolz, Uwe

AU - Dreifuss, Bradley

AU - Nelson, Sara W.

AU - Hammerstedt, Heather

AU - Andinda, Jovita

AU - Maling, Samuel

AU - Bisanzo, Mark

PY - 2015/4/7

Y1 - 2015/4/7

N2 - 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) 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. was 6.5% overall and 6.8% for under-fives.

AB - 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) 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. was 6.5% overall and 6.8% for under-fives.

UR - http://www.scopus.com/inward/record.url?scp=84928966425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928966425&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0122559

DO - 10.1371/journal.pone.0122559

M3 - Article

C2 - 25849960

AN - SCOPUS:84928966425

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 4

M1 - e122559

ER -