title: Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes.
abstract: BACKGROUND
  Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients.
  
  
  METHODS
  Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit.
  
  
  RESULTS
  Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives.
  
  
  CONCLUSIONS
  This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors: Stacey
authors: S
authors: Chamberlain
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America.
authors: Uwe
authors: U
authors: Stolz
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America.
authors: Bradley
authors: B
authors: Dreifuss
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Department of Emergency Medicine, Maine Medical Center, Portland, Maine, United States of America.
authors: Sara W
authors: SW
authors: Nelson
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Idaho Emergency Physicians, Boise, Idaho, United States of America.
authors: Heather
authors: H
authors: Hammerstedt
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Karoli Lwanga Hospital, Nyakibale, Uganda.
authors: Jovita
authors: J
authors: Andinda
authors: Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Samuel
authors: S
authors: Maling
authors: Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda; Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts, United States of America.
authors: Mark
authors: M
authors: Bisanzo
mesh_terms: D000208:Acute Disease / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult