Lower-Middle Income Countries Grant Awards Made

Prevalence, associated factors and interventions of burnout & work-place stress in ED healthworkers & trainees in Uganda

Date of award: August 2022

Lead applicant:  Dr Jonathan Kajjimu (jonathkebenz37@gmail.com)

Type of research: Mixed methods study

Country involved: Uganda

Summary of project:

Using a descriptive cross-sectional survey, in-depth interviews and focus group discussions to study the extent of the threat of burnout, contributing factors and potential solutions amongst healthcare workers in Ugandan emergency departments Ugandan with a view to advocating for appropriate resources to support staff retention.

Publications/presentations: due to commence January 2023

Using tele-simulation to build capacity for paediatric emergency medicine trauma care in health care workers in India

Date of award: December 2021

Lead applicant:  Dr Ankur Verma (anksv25@gmail.com)

Type of research: Mixed methods study

Country involved: India

Summary of project:

Using India as a case example, we will create contextually appropriate paediatric trauma cases and develop detailed case scenarios which we will then use to create moulage videos. The knowledge and competency levels will be set for a variety of different health care providers and the content will be based on established standards of care such as the WHO BEC course and ATLS principles. We will then test the content material with trainers and finally deliver the paediatric trauma tele-simulation training to a variety of different health care providers based on the existing learning from tele-sim. Through, surveys, focus group discussions and interviews of the participants we will assess the value of this intervention while also exploring the challenges.

Publications/presentations: project in progress

The application of mobile software to decrease length of stay in the Emergency Medicine and critical Care department of Hiwot Fana specialized university hospital, Harar, Ethiopia:  Quasi-Experimental study design

Date of award: December 2021

Lead applicant:  Asst. Professor Nathan Muluberhan (natanxy@gmail.com)

Type of research: Quasi-experimental/quality improvement

Country involved: Ethiopia

Summary of project:
The project aims to calculate the length of stay for patients admitted to the Emergency department of Hiwot Fana specialized university hospital, Harar, Ethiopia. It then aims to identify the factors influencing prolonged length of stay using survey data and focus groups.  Subsequently, after implementing a mobile phone notification system (developed during the study) which will provide real-time data to staff regarding length of stay and those likely to have prolonged stays, the research team will calculate whether there has been a decrease in length of stay for patients overall.

Publications/presentations: under ethical review locally pending commencement

Trauma Assessment, Procedures and Pathways in the Emergency Department (TrAPPED): A Rwandan Study

Date of award: December 2020

Lead applicant:  Dr Najeeb Rahman (najeebrahman@nhs.net)

Type of research: Mixed methods study

Country involved: Rwanda

Summary of project:
Trauma represents a significant burden in Rwanda, accounting for more than 50% of emergency department admissions to the primary referral hospital in Kigali. However, there is little published literature on the details of trauma pathways. This study sought to describe the features and characteristics of current trauma care for adults at 2 national referral hospital sites in Kigali, thereby contributing to pathway description and recommendations for improvement.

Publications/presentations: delayed start date with expected outputs in 2023.

Sri Lanka Out-of-Hospital Cardiac Arrest Study (SLOCAS)

Date of award: November 2020

Lead applicant: Dr Kaushila Thilakasiri (kaushila@gmail.com)

Type of research: Observational study

Country involved: Sri Lanka

Summary of project:
The purpose of this observational research is to analyse data associated with out-of-hospital cardiac arrest (OHCA) in Sri Lanka, using the existing platform of “Suwaseriya”: the free national ambulance Service. This will help to estimate the scale of the problem of OHCA in Sri Lanka for the first time. This research will be valuable in developing policies and strategies to implement both by-stander CPR training and public-access automated external defibrillators along with expansion of emergency ambulance services to reduce preventable deaths in developing countries.

Publications/presentations: data collection in progress following pandemic-related delay

An exploration of factors that influence the implementation and establishment of formal triage systems in Uganda

Date of award: January 2020

Lead applicant:  Afizi Kibuuka (najeebrahman@nhs.net)

Type of research:  Mixed methods study

Country involved: Uganda

Summary of project:
Early recognition of serious illness and injury is critical to reducing mortality and morbidity and is a pillar of emergency care. The Triage Interventions, Processes and Procedures in the Emergency Department (TrIPPED) study sought to explore the factors that influence implementation and establishment of the formal triage systems in Uganda. This was done by conducting staff surveys, interviews as well as observation in 4 referral hospitals in Uganda. The project was primarily managed by local Ugandan colleagues. One of the key objectives was to ensure commentary from a ‘human factors’ perspective so as to pragmatically inform stakeholders on triage establishment.

Publications/presentations:
RCEM ASC Virtual  2021
Report in progress

The development of a community first aid responder programme in the Democratic Republic of Congo

Date of award: November 2019

Lead applicant:  Dr Ken Ngoy Diango (k.d.ngoy@gmail.com)

Type of research: Mixed methods study

Country involved: Democratic Republic of Congo

Summary of project:
This project aim is to develop a country-specific Community First Aid Responder (CFAR) programme as an initial step to increasing prehospital capacity.

The first part of the study is a baseline evaluation which mapped the DRC emergency care system using the WHO Emergency Care System Assessment tool

The second part is a community-based cross-sectional survey which evaluated the needs and supply of emergency care in Kinshasa, DRC. Concomitant to this survey, the research team evaluated the awareness, attitude and perceived knowledge regarding First Aid in Kinshasa’s households.

The third part on needs assessment and acceptability of a CFAR programme in Kinshasa, DRC is a qualitative study

The last part on the implementation and evaluation of a pilot World Health Organisation’s Community First Aid Responder training in Kinshasa, DRC is a mixed methods analysis delving into a methodical evaluation of key aspects of the implementation of a pilot CFAR training and perspectives of both organisers and participants in order to inform future rollouts and related research.

Publications/presentations:
DRC Emergency Care System Assessment Report.

Diango K, Yangongo J, Sistenich V, et al. Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey. BMJ Open 2022;12:e060036. http://dx.doi.org/10.1136/bmjopen-2021-060036

Diango K, Yangongo J, Sistenich V, et al. Awareness, attitude and perceived knowledge regarding First Aid in Kinshasa, Democratic Republic of Congo: A cross-sectional household survey. https://doi.org/10.1016/j.afjem.2022.03.001

Reform of emergency care in low-income countries

Date of award: January 2018

Lead applicant:  Dr Ahmed El tahir Osman Ali (ahmedaltahir@gmail.com)

Type of research: Operational health system research

Country involved: Sudan

Summary of project:
LMIC emergency care system reform data will be scoped using a systematic review of the literature. This will be followed by an assessment of 10 emergency units in Sudan using the WHO Emergency Unit Assessment Tool to generate baseline data.

6-months of process and clinical outcome (mortality) data will be collected from the each unit on 5 sentinel conditions (paediatric diarrhoea, pneumonia, asthma, road crashes, post-partum haemorrhage) as a baseline from which to measure impact. Sn individualised, site-specific improvement plan will then be driven by the results of the assessment and implemented in an initial concentrated package, followed by ongoing training and support

Publications/presentations: Political instability in Sudan led to the re-focussing of this grant which will now study a qualitative evaluation of emergency care system interventions with a focus on the Interagency Integrated Triage Tool (IITT) and WHO clinical checklists in low and middle-income countries (LMIC). The expected outputs are envisaged to provide a better understanding of how to incorporate qualitative elements into designing and evaluating emergency care system interventions.

Senior Doctor Initial Assessment in Triage: Staff Perspectives

Date of award: August 2016

Lead applicant:  Zakaria Marwarn (Mariozakaria00@gmail.com)

Type of research: Qualitative study

Country involved: Iraq

Summary of project: A qualitative study exploring the perspectives of emergency doctors on the implementation of triage, their experience, and the effect on patient care in Iraqi hospitals.

Publications/presentations: To Be Confirmed

Strengthening Emergency Care Systems in Low Income Countries

Date of award: August 2016

Lead applicant:  Lee Wallis (lee.a.wallis@gmail.com)

Type of research: Epidemiology

Countries involved: Tanzania & Uganda

Summary of project: Mortality and process data were collected on 6000 patients over 12 months at 4 district hospitals – 2 in Tanzania, 2 in Uganda – who presented at the emergency unit with 1 of 5 sentinel conditions: injury, pneumonia, asthma, paediatric gastro, or post-partum haemorrhage. Overall mortality rate was 3.27% across all sites.

Beyond the grant, the next phase of the project involves the implementation of an emergency care intervention package developed by WHO. Post-intervention data have been collected immediately after implementation at each site and a comparative analysis of pre- and post- intervention data will be performed to evaluate the impact of the intervention. A post intervention sample of 6000 patients has been recruited.

Publications/presentations: the work informed WHO’s evidence base for impact of emergency care interventions but has not yet been published in the scientific literature.

Estimating the weight of children and adults in emergency medicine & accuracy of weight estimation methods in adults, adolescents and children: a prospective study

Date of award: August 2016

Lead applicant:  Appolinaire Manirafasha (maniappo@gmail.com)

Type of research: Derivation/validation study

Country involved: Rwanda

Summary of project:

First study question compared the accuracy of various weight estimation methods to derive a dedicated age-based tool within a Rwandan setting.

Second study question assessed weight estimation methods in patients of all ages in Rwanda compared to other methods used in developed countries

Publications/presentations

RECA Kigali 2017 (oral presentation & abstract published in AfJEM)

RCEM ASC Liverpool 2017 (poster presentation x2)

RCEM Research Engagement Day Virtual 2022 (oral presentation)

Manirafasha A, Yi S, Cattermole GN. Estimating children’s weight in a Rwandan emergency centre. African J Emerg Med 2018; 8: 55–58

Cattermole GN, Manirafasha A. Accuracy of weight estimation methods in adults, adolescents and children: a prospective study. Emerg Med J 2021; 38: 718-723