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Delays in arrival and treatment in emergency departments: Women, children and non-trauma consultations the most at risk in humanitarian settings.
Beltrán Guzmán, Isabel; Gil Cuesta, Julita; Trelles, Miguel; Jaweed, Omar; Cherestal, Sophia; van Loenhout, Joris Adriaan Frank; Guha-Sapir, Debarati.
Afiliação
  • Beltrán Guzmán I; Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
  • Gil Cuesta J; Operational Centre Geneva, Médecins Sans Frontières, Geneva, Switzerland.
  • Trelles M; Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
  • Jaweed O; Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
  • Cherestal S; Mission Afghanistan, Médecins Sans Frontières, Kunduz, Afghanistan.
  • van Loenhout JAF; Mission Haiti, Operational Centre Brussels, Médecins Sans Frontières, Port-au-Prince, Haiti.
  • Guha-Sapir D; Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
PLoS One ; 14(3): e0213362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835777
ABSTRACT

INTRODUCTION:

Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings.

METHODOLOGY:

This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays.

RESULTS:

We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2-1.3), children <5 (OR 1.4, 95% CI 1.4-1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6-35.3) and non-trauma cases (OR 4.7, 95% CI 4.4-4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0-1.1), children <5 (OR 2.0, 95% CI 1.9-2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9-15.4) and non-trauma cases (OR 1.6, 95% CI 1.5-1.7).

CONCLUSIONS:

Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Tratamento de Emergência / Tempo para o Tratamento Tipo de estudo: Estudo de prevalência Limite: Adolescente / Adulto / Idoso / Criança / Criança, pré-escolar / Feminino / Humanos / Lactente / Masculino / Meia-Idade País/Região como assunto: África / Ásia / Caribe / Haiti Idioma: Inglês Revista: PLoS One Assunto da revista: Ciência / Medicina Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Bélgica

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Serviço Hospitalar de Emergência / Tratamento de Emergência / Tempo para o Tratamento Tipo de estudo: Estudo de prevalência Limite: Adolescente / Adulto / Idoso / Criança / Criança, pré-escolar / Feminino / Humanos / Lactente / Masculino / Meia-Idade País/Região como assunto: África / Ásia / Caribe / Haiti Idioma: Inglês Revista: PLoS One Assunto da revista: Ciência / Medicina Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Bélgica