Majamanda Maureen Daisy, Joshua Gondwe Mtisunge, Makwero Martha, Chalira Alfred, Lufesi Norman, Dube Queen, Desmond Nicola
Department of Medical and Surgical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi.
Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya.
Compr Child Adolesc Nurs. 2021 May 24;45(2):201-216. doi: 10.1080/24694193.2021.1916127.
Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals.
初级卫生保健机构是马拉维医疗保健系统的一个切入点。这些机构面临的挑战包括资源有限（物资和人力）、医护人员在应急管理方面知识、技能和态度不佳或不足，以及从初级保健层面转诊到其他护理层面的延迟。这些因素导致了不良后果，包括儿童在入院后24小时内死亡。在初级保健层面培训医护人员和辅助人员进行急诊分诊评估与治疗（ETAT），有助于改善对急重症患儿的护理。初级保健机构的医护人员和辅助人员接受了儿科ETAT培训。医护人员的培训教材改编自卫生部针对地区和三级医疗保健机构的ETAT培训。辅助人员的培训内容侧重于在紧急情况下进行救生的非技术职责。为初级卫生保健机构提供了一个最低限度的治疗包，包括应急设备、物资和药品。每季度进行一次支持性监督访问。医护人员培训手册改编自卫生部的教材，辅助人员培训手册则根据改编后的教材编写。共有877人接受了培训（336名医护人员和541名辅助人员）。培训后，患者分诊得到改善，患者被按照急诊、优先或非紧急情况进行处理。这减少了转诊病例数量，儿童在转诊前病情得到稳定。儿科ETAT方面医护人员和辅助人员的能力建设以及提供基本的卫生中心配套措施改善了初级保健层面的医疗实践。通过机构指导以及岗前和在职培训，这种实践得以持续。在初级卫生保健机构进行分诊和治疗，包括稳定有危险体征儿童的病情，改善了患者的急诊护理，减轻了转诊医院的患者负担，并增加了成功转诊的数量。
