title: Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda.
abstract: BACKGROUND
  Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)-a locally adapted pediatric advanced life support management program-in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children.
  
  
  METHODS
  A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children.
  
  
  RESULTS
  Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated.
  
  
  CONCLUSIONS
  Our assessment provides evidence to inform new strategies to enhance the capacity of Rwandan district hospitals to provide pediatric advanced life support management. Identifying key gaps in the health care system is required in order to facilitate the implementation and scale up of ETAT+ in Rwanda. These findings also highlight a need to establish an outreach/mentoring program, embedded within the ongoing ETAT+ program, to promote cross-hospital learning exchanges.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Celestin
authors.identifier: http://orcid.org/0000-0001-7808-4652
authors.initials: C
authors.lastname: Hategeka
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
authors.affiliation: Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda.
authors.forename: Lisine
authors.initials: L
authors.lastname: Tuyisenge
authors.affiliation: Division of Neonatal-Perinatal Medicine; Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kenyon
authors.affiliation: Schulich School of Medicine and Dentistry, Department of Anatomy & Cell Biology, Western University, London, Ontario, Canada.
authors.forename: David F
authors.initials: DF
authors.lastname: Cechetto
authors.affiliation: Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.|Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
mesh_terms: D002648:Child; D000067576:Child Health / Q000639:trends*; D002675:Child, Preschool; D003695:Delivery of Health Care; D003906:Developing Countries; D004638:Emergency Treatment; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000070316:Pediatric Emergency Medicine; D012432:Rwanda / Q000453:epidemiology; D014218:Triage