Functional availability of medical oxygen for the management of hypoxaemia in Cameroon: A nationwide facility-based cross-sectional survey.

Background: Medical oxygen is essential for managing hypoxaemia, which has a multifactorial origin, including acute and chronic lung diseases such as pneumonia, asthma, and severe malaria. The coronavirus disease 2019 (COVID-19) revealed substantial gaps in the availability and accessibility of safe medical oxygen, especially in low- and middle-income countries (LMICs). This study aimed to assess the availability and sources, as well as the barriers to the availability of functional medical oxygen in hospitals in Cameroon. Methods: This was a nationwide cross-sectional descriptive study conducted from 26 March to 1 June 2021. Using a convenient sampling technique, we sampled accredited public and private COVID-19 treatment centres in all ten regions in Cameroon. Representatives from the selected hospitals were provided with a pre-designed questionnaire assessing the availability, type, and state of medical oxygen in their facilities. All analyses were performed using R. Results: In total, 114 hospitals were included in this study, with functional medical oxygen available in 65% (74/114) of the hospitals. About 85% (23/27) of the reference hospitals and only 59% (51/87) of the district hospitals had available functional medical oxygen. Compared to district hospitals, reference hospitals were more likely to have central oxygen units (reference vs. district: 10 vs. 0%), oxygen cylinders (74 vs. 42%), and oxygen concentrators (79 vs. 51%). The most common barriers to the availability of medical oxygen were inadequate oxygen supply to meet needs (district vs. reference hospitals: 55 vs. 30%), long delays in oxygen bottle refills (51 vs. 49%), and long distances from oxygen suppliers (57 vs. 49%). Conclusions: The availability of medical oxygen in hospitals in Cameroon is suboptimal and more limited in districts compared to reference hospitals. The cost of medical oxygen, delays related to refills and supplies, and long distances from medical sources were the most common barriers to availability in Cameroon.

Monitoring of characteristics of the patients visiting an emergency center in Cameroon through the development of hospital patient database.

Most countries in Sub-Saharan Africa have struggled to utilize health information technology and thus lack in accurate patient data. This paper describes the method of collecting patient data and patient characteristics in an emergency centre in Yaoundé, Cameroon. We developed an Epi InfoTM-based data entry form to collect data of the patients who visited the Centre des Urgences de Yaoundé (CURY) from January 2016 to June 2018. Demographic, clinical symptoms, treatments and outcome data were collected. Additional data on the patients with multiple trauma, chest pain, sepsis/septic shock, and stroke were also collected. During the study period, a total of 18,875 patients' data were collected (44.5% women, median age of 36). Of the total patients, 2.4% had chest pain, 2.7% had stroke, 1.9% had sepsis/septic shock, and 1.6% had multiple trauma. About 6.0% patients received operation and majority of patients were discharged either normally (48.2%) or with continuity of care (26.3%). About 5.0% of patients were transferred to other hospital and 5.2% of patients were dead. This study serves to broaden understanding of the emergency patients in Yaoundé, Cameroon.

White Paper on Early Critical Care Services in Low Resource Settings.

This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient-these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single "best" care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country's current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient's geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.

Analysing the literature: A research primer for low- and middle-income countries.

Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.

Changes in the healthcare utilization after establishment of emergency centre in Yaoundé, Cameroon: A before and after cross-sectional survey analysis.

In effort to address the shortage of emergency medical care in Cameroon, the Yaoundé Emergency Center (CURY) was established in June, 2015 in Yaoundé, Cameroon. To evaluate its impact on the communities of Yaoundé, we assessed the changes in utilizations of emergency medical care since the establishment of the CURY. In 2014 the first survey was conducted on randomly selected 619 households (3,201 individuals) living in six health districts of Yaoundé. In 2017 the second quantitative survey was conducted on 622 households (3,472 individuals) using the same survey methods as the first survey. In both surveys, data on demographic information, socioeconomic status, and utilization of healthcare, including emergency care in the past year were collected on every member of the households via face-to-face interview. Data on two surveys were compared. Participants in the both surveys had similar age and gender distribution with mean age of 21-22 and 46% being male. In 2014 survey, healthcare utilization rates for emergency unit, outpatient, and hospitalization were 4.8%, 36.7%, and 10.0%, respectively. In 2017 survey, corresponding rates were 5.8%, 32.5%, and 9.2%%, respectively. The increase in the utilization of emergency unit between two surveys showed a marginal statistical significance (p = 0.08), while outpatient utilization showed statistically significant decrease from 2014 to 2017 survey (from 36.7% to 32.5%; p <0.001). After the establishment of a dedicated emergency medical center in Yaoundé, Cameroon, the utilization of emergency care was increased in the Yaoundé community. Further studies are warranted to examine the direct effect of the establishment of the CURY on healthcare utilization in Yaoundé.

Evaluating emergency care capacity in Africa: an iterative, multicountry refinement of the Emergency Care Assessment Tool.

Healthcare facilities in low-income and middle-income countries lack an objective measurement tool to assess emergency care capacity. The African Federation for Emergency Medicine developed the Emergency Care Assessment Tool (ECAT) to fulfil this function. The ECAT assesses the provision of key medical interventions (signal functions) that emergency units (EUs) should be able to perform to adequately treat six common, life-threatening conditions (sentinel conditions). We describe the piloting and refinement of the ECAT, to improve usability and context-appropriateness. We undertook iterative, multisite refinement of the ECAT. After pilot testing at a South African referral hospital, subsequent studies occurred at district, regional and central facilities across four countries representing the major regions of Africa: Cameroon, Uganda, Egypt and Botswana. At each site, the tool was administered to three participants: one senior physician, one senior nurse and one other clinical provider. Feedback informed refinements of the ECAT, and an updated tool was used in the next-studied country. Iteratively implementing refined versions of the tool in various contexts across Africa resulted in a final ECAT that uses signal functions, categorised by sentinel conditions and evaluated against discrete barriers to emergency care service delivery, to assess EUs. It also allowed for refinement of administration and data analysis processes. The ECAT has a total of 71 items. Advanced facilities are expected to perform all 71 signal functions, while intermediate facilities should be able to perform 53. The ECAT is the first tool to provide a standardised method for assessing facility-based emergency care in the African context. It identifies where in the maturation process a hospital or system is and what gaps exist in delivery of care, so that a comprehensive roadmap for development can be established. Although validity and feasibility testing have now occurred, reliability studies must be conducted prior to amplification across the region.

The State of Emergency Medical Services (EMS) Systems in Africa.

Introduction Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury. METHODS: A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems' jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet. RESULTS: The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each). CONCLUSION: Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service. Mould-Millman NK , Dixon JM , Sefa N , Yancey A , Hollong BG , Hagahmed M , Ginde AA , Wallis LA . The state of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273-283.

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study.

OBJECTIVES: To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. DESIGN: A cross-sectional study using a community-based survey. SETTING: Yaoundé, Cameroon. PARTICIPANTS: All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. PRIMARY OUTCOME MEASURES: Unmet needs for emergency care. RESULTS: Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. CONCLUSIONS: Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon.