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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

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          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.

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          Most cited references35

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          A conceptual model of emergency department crowding.

          Brent Asplin, David Magid, Karin Rhodes … (2003)
          Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.
          Article 0 comments Cited 212 times – based on 0 reviews     Review now
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            Health literacy: addressing the health and education divide.

            I S Kickbusch (2001)
            Health literacy as a discrete form of literacy is becoming increasingly important for social, economic and health development. The positive and multiplier effects of education and general literacy on population health, particularly women's health, are well known and researched. However, a closer analysis of the current HIV/AIDS epidemics, especially in Africa, indicates a complex interface between general literacy and health literacy. While general literacy is an important determinant of health, it is not sufficient to address the major health challenges facing developing and developed societies. As a contribution to the health literacy forum in Health Promotion International, this paper reviews concepts and definitions of literacy and health literacy, and raises conceptual, measurement and strategic challenges. It proposes to develop a set of indicators to quantify health literacy using the experience gained in national literacy surveys around the world. A health literacy index could become an important composite measure of the outcome of health promotion and prevention activities, could document the health competence and capabilities of the population of a given country, community or group and relate it to a set of health, social and economic outcomes.
            Article 0 comments Cited 165 times – based on 0 reviews     Review now
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              Determinants of delay in care-seeking for febrile children in eastern Uganda.

              Göran Tomson, Stefan Peterson, George Pariyo … (2009)
              To explore factors associated with delay in seeking treatment outside the home for febrile children under five. Using a pre-tested structured questionnaire, all 9176 children below 5 years in Iganga-Mayuge Demographic Surveillance Site were enumerated. Caretakers of children who had been ill within the previous 2 weeks were asked about presenting symptoms, type of home treatment used, timing of seeking treatment and distance to provider. Children who sought care latest after one night were compared with those who sought care later. Those likely to delay came from the lowest socio-economic quintile (OR 1.45; 95% CI 1.06-1.97) or had presented with pallor (OR 1.58; 95% CI 1.10-2.25). Children less likely to delay had gone to drug shops (OR 0.70; 95% CI 0.59-0.84) or community medicine distributors (CMDs) (OR 0.33; 95% CI 0.15-0.74), had presented with fast breathing (OR 0.75; 95% CI 0.60-0.87), used tepid sponging at home (OR 0.43; 95% CI 0.27-0.68), or perceived the distance to the provider to be short (OR 0.72; 95% CI 0.60-0.87). Even in the presence of 'free services', poverty is associated with delay to seek care. Drug shops and CMDs may complement government efforts to deliver timely treatment. Health workers need to sensitize caretakers to take children for care promptly. Methods to elucidate time in population-surveys in African settings need to be evaluated.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Isabel Beltrán Guzmán:
                ORCID: http://orcid.org/0000-0003-2620-0396
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Julita Gil Cuesta: Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Miguel Trelles: Role: Data curationRole: SupervisionRole: Writing – review & editing
                Omar Jaweed: Role: Data curationRole: InvestigationRole: Resources
                Sophia Cherestal: Role: Data curationRole: InvestigationRole: Resources
                Joris Adriaan Frank van Loenhout:
                ORCID: http://orcid.org/0000-0001-7810-7738
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Debarati Guha-Sapir: Role: Funding acquisitionRole: Supervision
                Andrew Fu Wah Ho: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 5 March 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 3
                Electronic Location Identifier: e0213362
                Affiliations
                [1 ] Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
                [2 ] Operational Centre Geneva, Médecins Sans Frontières, Geneva, Switzerland
                [3 ] Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
                [4 ] Mission Afghanistan, Médecins Sans Frontières, Kunduz, Afghanistan
                [5 ] Mission Haiti, Operational Centre Brussels, Médecins Sans Frontières, Port-au-Prince, Haiti
                Duke-NUS Medical School, SINGAPORE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-2620-0396
                http://orcid.org/0000-0001-7810-7738
                Article
                Publisher ID: PONE-D-18-30484
                DOI: 10.1371/journal.pone.0213362
                PMC ID: 6400395
                PubMed ID: 30835777
                SO-VID: fd67f417-2f5e-4e84-b90d-b5909db9bfe5
                Copyright © © 2019 Beltrán Guzmán et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 22 October 2018
                Date accepted : 20 February 2019
                Page count
                Figures: 0, Tables: 5, Pages: 15
                Funding
                The present study is the result of Dr Beltrán’s work, done in parallel with her master’s dissertation. The Master is the EMMPHID (Erasmus Mundus Master in Public Health in Disasters), for which students were based at the CRED (Centre for Research on the Epidemiology on Disasters) at the Catholic University of Louvain in Brussels, Belgium. The institution will cover the submission fees. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the Authors received a salary from the EMMPHID project.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Education and Awareness
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Triage
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Social Sciences
                Subject: Sociology
                Subject: Culture
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Socioeconomic Aspects of Health
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Socioeconomic Aspects of Health
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Social Sciences
                Subject: Psychology
                Subject: Behavior
                Custom metadata
                Data Availability Due to the sensitive nature of the data, full datasets are not made available by default. Médecins Sans Frontiéres (MSF) research data are available under the MSF data sharing agreement with limitations related to sensitive data defined as: “Any data from which an implication of criminal conduct could be drawn and/ or that can put Data Subjects at serious risk (including death); this includes data on violence-related medical activities particularly but not exclusively in contexts of conflicts: (1) any data related to violence – bullet wounds…” The full MSF data sharing policy can be found at: http://fieldresearch.msf.org/msf/bitstream/10144/306501/1/MSF+data+sharing+policy+final+061213.pdf. Data are available through the MSF Data Sharing Agreement for researchers who meet the criteria for access to confidential data. Researchers requests should be addressed to the Data Sharing Agreement coordinator, Annick Antierens at Annick.Antierens@ 123456brussels.msf.org .

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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