Emergency situations.

Background
Emergency 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.
Methods
This 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.
Results
A 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.
Conclusion
Community-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.

【背景】
急诊医疗体系对于提升时间敏感性急症的救治质量至关重要。目前，撒哈拉以南非洲地区此类体系的建设与发展已成为优先议题。普通民众对急症症状的认知、识别以及后续的就医行为，是实现及时就医与规范治疗的关键。本研究旨在评估坦桑尼亚北部社区民众对急症的认知情况，以及当地民众在急诊医疗体系就医过程中面临的阻碍。

【方法】
本研究于2021年6月至9月期间，在坦桑尼亚乞力马扎罗省的三个行政区开展家庭横断面调查。本研究的主要结局指标为：对5种假想急症场景给出不当处置的比例。次要结局指标包括：家庭急症发生率，以及急症患者的就医延迟情况。研究采用描述性统计方法对数据进行分析；针对关注结局与选定家庭特征之间的关联，采用费希尔精确检验（Fisher’s Exact Tests）分析分类变量，采用威尔科克森秩和检验（Wilcoxon Rank-Sum Tests）分析连续变量。

【结果】
本研究共完成539户家庭的访谈，累计纳入2274名受访者。其中46.8%的受访者来自莫希行政区委员会。73.7%的受访者使用现金支付医疗费用，且无健康保险。受访家庭的月均收入为226107.6坦桑尼亚先令。共有76户（14.1%）家庭报告称，在过去一年中曾遭遇急症；225名受访者（41.7%）对至少1种假想急症场景给出了不当处置。就医延迟的受访者中，更高比例使用个人现金支付，且拥有国民健康保险的比例更低。对假想急症场景处置不当的受访者，更多居住在农村地区、无健康保险，且家庭月均收入更低。

【结论】
坦桑尼亚北部社区常住成年人对急症救治相关知识存在显著认知缺口，且此类急症的就医过程存在延迟。前往医疗机构的距离、医疗费用以及缺乏保险，可能是导致就医延迟的因素。扩大保险覆盖范围并完善急诊医疗服务体系，或可提升民众的就医可及性。