Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research

Hani Mowafi, Christine Ngaruiya, Gerard O'Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos Puyana, Akm Fazlur Rahman, Rashid Jooma, Blythe Beecroft, Junaid Razzak, Hani Mowafi, Christine Ngaruiya, Gerard O'Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos Puyana, Akm Fazlur Rahman, Rashid Jooma, Blythe Beecroft, Junaid Razzak

Abstract

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.

Keywords: emergency care; lmics; registries; research; surveillance.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
DALYs per 100 000 population attributable to emergency conditions by aetiology: separated by income level (A) and region (B). CD, communicable disease; DALYs, disability-adjusted life years; NCD, non-communicable disease.
Figure 2
Figure 2
Sustainable Development Goal #3: health, targets affected by emergency care.
Figure 3
Figure 3
PRISMA diagram of literature search LMIC emergency care registries and surveillance. HIC, high-income countries; LMICs, low-income and low middle-income countries; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 4
Figure 4
Emergency care surveillance and registry articles in LMICs 2007–2016. LMICs, low-income and low middle-income countries.
Figure 5
Figure 5
Model for emergency care surveillance and research opportunities: (A) prehospital; (B) emergency unit; (C) postemergency. EMS, Emergency Medical Services; WHO, World Health Organization; MoH, Ministry of Health; IFEM, International Federation for Emergency Medicine; ED, Emergency Department; EM, Emergency Medicine.
Figure 6
Figure 6
Demographic and Health Survey (DHS) timeline: key survey question, module and biomarker milestones, 1985–2006.

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