Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service.

We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2-1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33-1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47-3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

Produção científica sobre nutrição no âmbito da Atenção Primária à Saúde no Brasil: uma revisão de literatura / Scientific output on nutrition in the scope of Primary Health Care in Brazil: a review of the literature

INTRODUÇÃO: Ações de nutrição na Atenção Primária à Saúde (APS) têm importante papel na promoção da saúde e na prevenção e tratamento de agravos. OBJETIVO: Mapear, sistematizar e avaliar a produção científica da nutrição no âmbito da APS no Brasil. MÉTODOS: Trata-se de uma revisão de literatura. A busca de artigos foi feita no PubMed e Lilacs, utilizando descritores referentes à APS e à nutrição. Foram levantados estudos conduzidos no Brasil, com profissionais ou população atendida pelo SUS na APS e publicados até março de 2011. Ainda, foram consultadas as referências dos artigos selecionados, a fim de identificar outros estudos. RESULTADOS: Do total de artigos localizados, 68 foram elegíveis e 49 foram identificados nas listas de referências, totalizando 117 artigos analisados. Estes foram, em sua maioria, artigos originais, quantitativos, conduzidos no estado de SP, pela USP e publicados de 2002 a 2011. Abordavam o diagnóstico, tendo como objeto a avaliação do estado nutricional e envolviam crianças. CONCLUSÃO: A produção na área é crescente, porém há necessidade de redirecionar a abordagem e o objeto de futuros estudos, focando em modelos de intervenção e em avaliação de programas.

Nutrition campaigns in Primary Health Care (PHC) play an important role in health promotion and the prevention and treatment of injuries. The scope of this paper is to chart and evaluate the scientific output of nutrition in Brazilian PHC. A search and review of the literature and papers was conducted on the PubMed and Lilacs databases, using key words related to PHC and nutrition. The studies were restricted to Brazil with the professionals or population assisted by PHC in the Brazilian Unified Health System and published prior to March 2011. The references in the selected articles were also consulted in order to identify additional studies. From the total of papers located, 68 were eligible and a further 49 were identified in the references lists, such that a total of 117 papers were analyzed. The studies reviewed were mostly original articles, using quantitative methodology, carried out by São Paulo University in that state and published from 2002 to 2011. The main issues were diagnosis seeking the evaluation of nutritional status involving children. The output in this field is growing, although there is a need to redirect the scope of future studies to a focus on intervention models and program evaluation.