title: Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya.
abstract: OBJECTIVE
  Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting.
  
  
  METHODS
  We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding.
  
  
  RESULTS
  No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines.
  
  
  CONCLUSIONS
  Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Sagam Community Hospital, Luanda, Kenya.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Hines
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Sagam Community Hospital, Luanda, Kenya.
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Walters
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Rachel Eleanor
authors.initials: RE
authors.lastname: Anderson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Tom
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Clark
authors.affiliation: Sagam Community Hospital, Luanda, Kenya.
authors.forename: Walter
authors.initials: W
authors.lastname: Obita
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Sagam Community Hospital, Luanda, Kenya.
authors.forename: Brett D
authors.identifier: http://orcid.org/0000-0002-5049-1798
authors.initials: BD
authors.lastname: Nelson
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya
keywords: ACCIDENT & EMERGENCY MEDICINE; TRAUMA MANAGEMENT