Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: a prospective cohort study

Introduction: The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, inperson course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BECApp) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting. Methods: We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts. Results: A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%. Discussion: Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: a needs assessment for improving healthcare resource management

Background:Appropriate referrals of injured patients could improve clinical outcomes and management ofhealthcare resources. To gain insights for system development, we interrogated the current situation by assessingburden, patient demography, causes of injury, trauma mortality and the care-process.Methods:We used an observational, cross-sectional study design and convenience sampling to review patientcharts from 3 major hospitals and the death registry in Tanzania.Results:Injury constitutes 9­13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however,the trauma death registryfigures exceeded the'inpatient deaths'and recorded up to 16%. Most patients arrivethrough a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the traumaadmissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%)were the leading causes of injury. The care process revealed a normal primary-survey rate of 73­90%.Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and dis-ability (80%). Most patients had non-operative management (42­57%) or surgery for wound care or skeletalinjuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were eachperformed in 10%.Conclusion:The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded inthe death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process,funding and recording. We found a functional hospital referral-network, transport system, and death registry

Neurologic emergencies in resource-limited settings: a review of stroke care considerations

Background: The current guidelines and evidence supporting acute stroke management have limitations in resource austere environments despite being a leading cause of death worldwide. Developing countries face a rapidly increasing and disproportionate burden of cerebrovascular disease yet differences in setting and resource limitations bring challenges that have a major influence in management options - especially with routine imaging and interventional considerations. In addition; general awareness; diagnosis and management of stroke remain poor.Objectives :To outline current acute stroke management and critical interventions that should be integrated into current practice while highlighting resource-limited care considerations.Methods :A systematic search of Ovid MEDLINE and reference lists of the literature on stroke; guidelines; and acute stroke management including care considerations in resource-limited settings was conducted through March 2014. Recommendations :Within emergency medicine; emphasis should be placed on establishing a robust stroke assessment and care process that is resource appropriate and scalable. Adherence as resources allow to current stroke care guidelines including acute management; stroke center coordination; palliation and resource allocation may improve outcomes. Further research related to resource-limited management is essential. Risk reduction through population-based interventions and early recognition may help to reduce the burden of disease