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Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Published online by Cambridge University Press:  15 November 2018

Sunkaru Touray Open the ORCID record for Sunkaru Touray [Opens in a new window] ,
Baboucarr Sanyang ,
Gregory Zandrow  and
Isatou Touray
Sunkaru Touray*
Affiliation:
University of New Mexico School of Medicine, Albuquerque, New MexicoUSA University of Massachusetts Medical School, Worcester, MassachusettsUSA
Baboucarr Sanyang
Affiliation:
Serekunda General Hospital, Ministry of Health & Social Welfare, Gambia
Gregory Zandrow
Affiliation:
University of Massachusetts Medical School, Worcester, MassachusettsUSA
Isatou Touray
Affiliation:
Ministry of Health & Social Welfare, Republic of Gambia
*
Correspondence: Sunkaru Touray, MB, ChB, MSc Assistant Professor of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico USA E-mail: sunkaru_touray@carlsbadmedicalcenter.com
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Abstract

Background

The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.

Problem

Data on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.

Methods

A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.

Results

Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.

Conclusion

: There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country.

TourayS, SanyangB, ZandrowG, TourayI. Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care. Prehosp Disaster Med. 2018;33(6):650–657.

Keywords

acute medical emergenciesGambiahealth insurancelow- and middle-income countriesmortalitytravel time
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 6 , December 2018 , pp. 650 - 657
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflict of interest: The authors have no conflicts of interest with regard to the content of this manuscript.

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