WHO Bulletin – Emergency care in low- and middle-income countries: a systematic review

‘Emergency facilities in LMICs serve a large, young patient population with high levels of critical illnesses and mortality. This suggests that emergency care should be a global health priority.’ This is the conclusion of a systematic review in the August 2015 issue of the WHO Bulletin. The citation and abstract are shown below, and the full text is available here:


I would be interested to hear from HIFA members about the quality of health care provided in emergency departments in LMICs, and how it might be improved.

CITATION: Emergency care in 59 low- and middle-income countries: a systematic review

Ziad Obermeyer, Samer Abujaber, Maggie Makar, Samantha Stoll, Stephanie R Kayden, Lee A Wallis, Teri A Reynolds & on behalf of the Acute Care Development Consortium

Bulletin of the World Health Organization Past issues Volume 93: 2015 Volume 93, Number 8, August 2015, 513-588


Objective: To conduct a systematic review of emergency care in low- and middle-income countries (LMICs).

Methods: We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.

Findings: We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.

Conclusion: Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  


3 thoughts on “WHO Bulletin – Emergency care in low- and middle-income countries: a systematic review

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