Paediatric Emergency Care South Africa
Children form a substantial proportion of EC visits worldwide. In the UK approximately 3.5 million children attend EC’s each year and they account for 25-30% of all EC visits . Precise figures for EC visits by children in Africa are not available – but one study in the Western Cape, South Africa found that 31.8% of EC attendances were paediatric patients .
Despite the high proportion of attendance by paediatric patients there is evidence that many EC’s are under-prepared for handling paediatric emergencies. Only 6% of EC’s in the United States (US) have all the equipment and supplies recommended for paediatric emergencies . And in the UK 28% of acute hospital trusts were rated as “weak” for children’s emergency services . Specific data are lacking but it is reasonable to that emergency services for children in Africa are significantly poorer than in the developed world, given the lower staffing ratios, lack of skills and resources and higher acuity of patients.
Ill children present a host of challenges to the emergency practitioner – whether they are pre-hospital personnel, nursing staff or emergency physicians. To mention just a few of the problems: the spectrum of diseases is markedly different from adults; the history is often obtainable only from carers; examination is complicated by lack of co-operation; vital signs are tricky to measure and normal values change with age; equipment needs to be adapted to the size of the child and drug doses must be calculated by weight. Furthermore the skills required to perform even simple procedures such as phlebotomy, intravenous cannulation and intubation can only be mastered with experience and specific training.
A proposal has been put forward for Paediatric Emergency Care South Africa (PECSA) to be formed with-in EMSSA. PECSA would focus on all aspect of emergency care of children in the African setting. Key areas would include advising on appropriate equipment, resources and training to deal with paediatric emergencies in low resource countries. The development and dissemination of best-practice guidelines, appropriate for children’s emergency care in resource-constrained settings, would be another important function.
Encouraging child-friendly environments and practices such as early pain assessment and management and avoidance of unnecessary investigations and procedures are important for the comfort and well-being of sick children and their families. Yet these are very neglected aspects of emergency care in the developing world. PECSA could do much in terms of advocacy for such concepts and ideals to be instilled in the emerging EC’s of SA and Africa.
The Millennium Development Goal (MDG) no.4 aims for a two-thirds reduction in under-five mortality (UFM) rates from 1990 to 2015 . The final time-point for evaluation of achievement of this goal is very close and whilst globally UFM has fallen from 12.5 million in 1990 to 7.2million in 2011 sadly SA and much of Sub-Saharan Africa is far off track . The UFM rate in SA is 50.7/1000 live births which represents only a 0.8% annual rate of decline from 1990 to 2011 this compares with a 2.2% decline worldwide in the same period. It is estimated that SA, along with the majority of Sub-Saharan African countries, will only achieve MDG 4 sometime after 2040 .
PECSA would be fully committed to helping decrease child mortality and morbidity, in Africa and the developing world, through improved practices and care on the frontline.
Dr Baljit Cheema
On behalf of the PECSA Steering Committee
Download the IFEM Paediatrics Standards of Care Document
- Services for Children in Emergency Departments. Report of the Intercollegiate Committee for Services Children in Emergency Departments. April 2007
- Wallis LE, Twomey M. Workload and casemix in Cape Town emergency departments. SAMJ. December 2007; Vol. 97(12): 1276-1280
- Joint policy statement–guidelines for care of children in the emergency department. American Academy of Pediatrics; Committee on Pediatric Emergency Medicine; American College of Emergency Physicians; Pediatric Committee; Emergency Nurses Association Pediatric Committee Pediatrics. 2009 Oct;124(4):1233-43.
- Healthcare Commission. Improvement review into Services for Children in Hospital.Commission for Healthcare Audit and Inspection. February 2007. Accessible at: http://www.cqc.org.uk/_db/_documents/children_improving_services_Tagged.pdf
- United Nations General Assembly. United Nations Millenium Declaration. A/RES/55/2 edn. New York, NY: United Nations 2000.
- Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer- Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011 Sep 24;378(9797):1139-65.