Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Christine Ngaruiya

Second Advisor

Rachel Dreyer

Abstract

The Accident and Emergency (A&E) unit in Nigeria is a key entry point to access health care for patients with various diseases. Currently there are limited data assessing the functionality of these units and their capacity for care. This study aims to evaluate the functional capacity of A&Es in Nigeria and to identify factors impeding optimal care.We conducted a cross-sectional study of seven hospitals in Nigeria, randomly selecting one hospital from each of the six geopolitical zones, and purposively including National Hospital Abuja. We used a universal sampling technique interviewing all doctors and nurses identified as routine A&E staff. We used a modified version of the Emergency Care Assessment Tool (ECAT) which assesses provision of key medical interventions (signal functions) used to treat six common, life-threatening conditions (sentinel conditions) in the Emergency department. For each condition, there was a “bundle” of signal functions and respondents evaluated the frequency of performance of each of the signal functions in the setting of a given condition. Respondent-evaluated performance for each signal function is reported as “Generally Not Done”, “Sometimes Done” and “Always Done” (1, 2, and 3, respectively). To assess differences in the facilities’ capacity to manage varying conditions, the values obtained from each of the signal functions in the “bundle” for each condition, were averaged. To measure each facility’s overall performance, the values obtained from each of the signal functions across all conditions for a given facility, were also averaged. A total of Five hundred and three health care providers (393 doctors and 110 nurses) were interviewed. Of these, 390 were medical doctors and 110 nurses with 3 non-specified. Among the doctors, there were 7 consultants (post-residency), 235 residents, 143 general practitioners and 5 interns (or house officers). Of all conditions, respiratory failure had the lowest mean score of 2.53 (95% CI, 2.1 - 2.97) across all the facilities. Conversely, altered mental status had the highest: 2.77 (95% CI, 2.41 – 3). A two-way ANOVA test comparing mean scores for all sentinel conditions across all sites, returned an F statistic of 1.353 (p=0.27) showing that no significant difference exists among the mean scores obtained for the sentinel conditions. Of all the 7 sites studied, FMC Katsina representing the north-west geopolitical zone had the highest mean score of 2.90 (95% C.I 2.84-2.96) out of a maximum score of 3, while UCTH representing the south-south had the lowest mean score of 2.37 (1.92 – 2.91). A two-way ANOVA test comparing the mean scores of all sites (across all conditions) returned an F statistic of 3.621 (P<0.01), showing that a significant difference exists among the mean scores obtained for the sites This study provides insight into the capacity of emergency units in Nigeria to manage certain critical conditions, which reflect overall functionality. Our findings showed that while there was no significant difference in the facilities’ overall capacities to provide emergency care with varying sentinel conditions, some facilities overall performed better than others. The results showed FMC Katsina in Northwest region had the highest functional capacity while UCTH in the south-south region had the lowest functional capacity to handle emergencies. More research is needed to further explore the reasons underlying these regional differences. Furthermore, although the difference in performance of functions for respiratory failure may not be statistically significant, more research is needed to explore the state of respiratory care in Nigeria, especially in light of the ongoing COVID-19 pandemic.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/29/2023

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