Ross Madeline E, Wright Antoinette H, Luke Mark, Tamba Abraham, Hessou Heounohu Romello, Kanneh Stephen, Da-Tokpah Kumeinu, Bills Corey B
Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, United States of America.
University of Liberia, School of Public Health, Monrovia, Liberia.
PLOS Glob Public Health. 2023 Nov 20;3(11):e0002629. doi: 10.1371/journal.pgph.0002629. eCollection 2023.
The overwhelming burden of morbidity and mortality from injury and medical conditions requiring acute care are borne by low- and middle-income countries lacking accessible, quality care systems. Current evidence suggests the lack of prehospital care systems likely contributes to this disproportionate burden. As an initial step in a longitudinal, collaborative effort to strengthen the chain of survival for emergency conditions in Liberia, baseline attitudes and behaviors in accessing and utilizing emergency care were characterized. A multistage, proportional, cluster sampling frame was employed to conduct a cross-sectional, community-based survey of 800 households across rural Lofa County and the greater capital (Monrovia) metropolitan area. The primary outcome was facility-based utilization of emergency care within the 12 months prior to survey administration. 43.9% of individuals surveyed reported a visit to an emergency unit in the last year. Multivariable logistic regression revealed increased adjusted odds of facility-based emergency care utilization in households that were low-income, non-English-speaking, lacking electricity, or had a non-durable roof. Among these individuals, 23.6% had sought care from a community health worker, family/friend, clinic, pharmacy, or traditional healer prior. The majority of persons seeking care do so without ambulance services. 34.8% of all households have called a community member for a medical emergency, but 88.9% of survey respondents report no first aid training and cite barriers to rendering aid. This represents the first household survey to assess the perceptions and utilization of emergency care in Liberia. Formal pre-hospital care provision is limited and substantial barriers to emergency care access exist. First aid training and acceptance is lacking, despite frequent reliance on community-based aid during emergencies.
低收入和中等收入国家因缺乏可及的、高质量的医疗体系，在伤病及需要急诊护理的医疗状况方面承受着巨大的发病和死亡负担。现有证据表明，缺乏院前护理体系可能是造成这一不成比例负担的原因之一。作为加强利比里亚紧急情况生存链的纵向合作努力的第一步，我们对获取和利用紧急护理的基线态度及行为进行了特征描述。采用多阶段、按比例的整群抽样框架，对洛法县农村地区和大首都（蒙罗维亚）都会区的800户家庭进行了基于社区的横断面调查。主要结果是调查实施前12个月内基于医疗机构的紧急护理利用情况。43.9%的被调查个体报告在过去一年去过急诊科室。多变量逻辑回归显示，低收入、非英语、无电或屋顶不耐用的家庭中，基于医疗机构的紧急护理利用的调整后优势增加。在这些个体中，23.6%的人之前曾向社区卫生工作者、家人/朋友、诊所、药店或传统治疗师寻求过护理。大多数寻求护理的人在没有救护车服务的情况下就医。34.8%的家庭在医疗紧急情况下呼叫过社区成员，但88.9%的调查受访者报告没有接受过急救培训，并列举了提供援助的障碍。这是利比里亚首次评估紧急护理认知和利用情况的家庭调查。正式的院前护理服务有限，获取紧急护理存在重大障碍。尽管在紧急情况下经常依赖社区援助，但缺乏急救培训和接受急救培训的情况仍然存在。
