Academic journal article Bulletin of the World Health Organization

An Observational Study of Adults Seeking Emergency Care in Cambodia/ Une Etude Observationnelle Des Adultes Recourant Aux Soins D'urgence Au Cambodge/ Un Estudio Observacional De Adultos Que Solicitan Atencion De Emergencia En Camboya

Academic journal article Bulletin of the World Health Organization

An Observational Study of Adults Seeking Emergency Care in Cambodia/ Une Etude Observationnelle Des Adultes Recourant Aux Soins D'urgence Au Cambodge/ Un Estudio Observacional De Adultos Que Solicitan Atencion De Emergencia En Camboya

Article excerpt

Introduction

Emergency medicine is a neglected component of health-care systems in most low- and middle-income countries. Nearly half of deaths and one third of disability adjusted life-years lost in these countries could be avoided by applying the basic principles of emergency care. (1) However, despite the renewed interest shown by World Health Organization calls to expand emergency care infrastructure (2)--these systems remain underdeveloped in most low- and middle-income countries and access to high-quality care is limited. (1,3,4)

The current health-care system in Cambodia exemplifies this gap in the provision of essential emergency care. Since the Cambodian Ministry of Health was established in 1993, the country has relied on a combination of public and private providers and international nongovernmental organizations to fulfil the medical needs of its people. In 2012, in the public sector, 1080 health centres provided primary care, first aid and maternal and child care (designated the minimum package of activity) in rural areas, while 90 referral hospitals provided secondary and tertiary care--designated the complementary package of activity. Hospitals offering care at complementary package of activity level 2 and above are required to provide emergency care at all times and each has an onsite physician and nurse, with a midwife available for obstetric emergencies. (5) Nevertheless, many of these hospitals lack designated emergency departments, a formal triage process and staff trained in emergency medicine. Furthermore, emergency medicine is not recognized as a specialty by the Ministry of Health and there is no formal programme for training residents in the discipline.

As functional emergency care systems vary between countries and regions, (3) accurate characterization of patients seeking emergency care is essential for developing locally appropriate systems. The 2013 academic emergency medicine consensus conference identified the lack of data on chief complaints as a critical gap in global emergency care research. (6) The chief complaint is the primary consideration used by health-care providers to structure the evaluation and management of patients who present with an acute condition or with an acute presentation of a chronic disease. Moreover, the information obtained from a good understanding of chief complaints differs from that gleaned from discharge diagnoses. (7) In countries with mature emergency care systems, chief complaints are standardized and mapped. (8) However, few developing nations have the means to report or collate information on chief complaints, (6) even though these data are essential for resource allocation, training, research and syndromic surveillance.

The objectives of this study were to identify the characteristics and chief complaints of adults presenting for emergency care in Cambodia. Understanding the pattern of adult emergencies in Cambodia could help guide the development of policy on health-care interventions, such as triage systems and staff training for common conditions. This information could also provide a basis for future studies of the effectiveness and quality of emergency medical services and of patient outcomes.

Methods

We conducted a four-week observational study of unscheduled visits to two provincial government referral hospitals in Cambodia: Sampov Meas Provincial Hospital and Battambang Provincial Hospital. Both were classified at complementary package of activity level 3, which indicates they provided obstetric, emergency and surgical services in addition to a variety of specialty services. Sampov Meas Provincial Hospital has 162 inpatient beds and reported a total of 16426 visits in 2012, which resulted in 6704 admissions. Battambang Provincial Hospital is a larger facility with 220 inpatient beds. It reported 55 138 visits in 2012, resulting in 14411 admissions. All figures come from the Cambodian Ministry of Health database. …

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