Mchomvu Elisante, Mbunda Geoffrey, Simon Noemi, Kitila Faradji, Temba Yvan, Msumba Isaiac, Namamba Jabir, Kilindimo Said, Mgubike Hellen, Gingo Winfrid, Hatz Christoph, Paris Daniel H, Weisser Maja, Rohacek Martin
St Francis Referral Hospital, Ifakara, United Republic of Tanzania.
Division of Infectious Diseases, University Hospital, Basel, Switzerland.
Swiss Med Wkly. 2019 Feb 4;149:w20018. doi: 10.4414/smw.2019.20018. eCollection 2019 Jan 28.
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.
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.
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).
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.
关于撒哈拉以南非洲农村地区急诊科所做诊断的信息匮乏。目的是：评估新急诊科做出的不同诊断的频率，以确定相关医疗保健需求；并查明急诊科实施后院内死亡率是否会降低。
在这项观察性研究中，我们前瞻性地整理了坦桑尼亚伊法卡拉圣弗朗西斯转诊医院急诊科在1年期间所有就诊患者的诊断。此外，我们比较了急诊科实施前后的院内死亡率。
从2016年7月到2017年6月，共纳入35903例患者。中位年龄为33.6岁（范围1天至100岁），57%为女性，25%为5岁以下儿童，4%为孕妇，9%为住院患者。最常见的诊断是呼吸道感染（12.6%）、尿路感染（11.4%）、创伤（9.8%）、未分化发热性疾病（5.4%）和疟疾（5.2%）。各年龄组最常见的临床诊断为：5岁以下儿童下呼吸道感染（16.1%）；5至17岁青少年创伤（21.6%）；18至50岁人群尿路感染（13.5%）；50岁以上人群高血压急症（12.4%）。呼吸道感染在雨季的4月达到高峰，而疟疾在雨季结束3个月后达到高峰。研究期间院内死亡率没有下降（2015年为5.6%，2017年为7.6%）。
大多数确诊疾病为感染性或创伤性起源。由于缺乏诊断方法，大多数发热性疾病定义不明确。撒哈拉以南非洲农村地区需要创伤系统和用于发热性疾病的廉价准确诊断方法。
