Inappropriate emergency response.

BackgroundEmergency care systems are critical to improving care for time-sensitive emergency conditions. The growth and development of these systems in Sub-Saharan Africa is becoming a priority. Layperson knowledge and recognition of emergency symptoms and subsequent care-seeking behavior are key to achieving timely access to care and appropriate treatment. This study aimed to assess community knowledge of emergency conditions as well as barriers to accessing the emergency care system in Northern Tanzania.MethodsThis was a cross-sectional study of households in three districts in Kilimanjaro, Tanzania from June to September 2021. The primary outcome was an inappropriate response to any of five hypothetical emergency conditions. Secondary outcomes were the incidence of household emergencies and delay in care access for those with emergency conditions. Data were analyzed using descriptive statistics. Associations between the outcome of interest and select household characteristics were analyzed using Fisher’s Exact tests for categorical measures and Wilcoxon rank-sum tests for continuous measures.ResultsA total of 539 households were interviewed with 2,274 participants. The majority (46.8%) were from Moshi District Council. 73.7% used cash and/or had no insurance. The mean monthly household income was 226,107.6 Tanzanian Shillings. 76 (14.1%) households reported experiencing an emergency condition in the past year and 225 (41.7%) of respondents had an inappropriate response to at least one hypothetical emergency condition. A higher proportion of those with delayed access to healthcare paid with personal cash and a lower proportion had national health insurance. A higher proportion of those with inappropriate responses to hypothetical emergency conditions lived in rural districts, were uninsured, and had a lower mean income.ConclusionCommunity-dwelling adults in Northern Tanzania have significant gaps in understanding of emergency care conditions and delayed access to care for these conditions. Distance to the healthcare facilities, cost, and lack of insurance may contribute to care delays. Increasing insurance coverage and developing emergency medical services may improve access to care.

研究背景
急诊医疗系统（emergency care systems）对于提升时效性急诊病症的救治质量至关重要。近年来，撒哈拉以南非洲地区的急诊医疗系统发展与完善已成为优先级工作。普通民众对急诊症状的认知与识别，以及后续的就医行为，是实现及时救治与规范诊疗的关键环节。本研究旨在评估坦桑尼亚北部社区对急诊病症的认知水平，以及当地民众使用急诊医疗系统面临的障碍。

研究方法
本研究于2021年6月至9月在坦桑尼亚乞力马扎罗地区的三个行政区开展家庭横断面研究。主要结局指标为：对五项模拟急诊病症中任意一项存在不当应对行为。次要结局指标包括：家庭急诊事件发生率，以及发生急诊病症后的就医延迟情况。数据分析采用描述性统计方法；针对分类变量的结局指标与选定的家庭特征之间的关联分析，采用费希尔精确检验（Fisher’s Exact tests）；针对连续变量则采用威尔科克森秩和检验（Wilcoxon rank-sum tests）。

研究结果
本次研究共访谈539户家庭，累计纳入2274名受访者。其中46.8%的受访者来自莫希行政区，73.7%的家庭使用现金支付医疗费用且/或未参保，家庭月均收入为226107.6坦桑尼亚先令。76户家庭（占比14.1%）报告称在过去一年内发生过急诊事件，225名受访者（占比41.7%）对至少一项模拟急诊病症存在不当应对行为。就医延迟的受访者中，使用个人现金支付的比例更高，而拥有国民医疗保险的比例更低。对模拟急诊病症存在不当应对行为的受访者中，居住在农村地区、未参保以及家庭月均收入更低的人群占比更高。

研究结论
坦桑尼亚北部社区居住的成年人对急诊病症的认知存在显著不足，且针对此类病症的就医存在延迟情况。距离医疗机构的路程、医疗费用负担以及缺乏保险保障，可能是导致就医延迟的关键因素。扩大医疗保险覆盖范围并完善急诊医疗服务体系，或可有效提升民众的就医可及性。