Mortality related to acute illness and injury in rural Uganda: Task shifting to improve outcomes

Stacey Chamberlain, Uwe Stolz, Bradley Dreifuss, Sara W. Nelson, Heather Hammerstedt, Jovita Andinda, Samuel Maling, Mark Bisanzo

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. Methods Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. Findings Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) Interpretation This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening. was 6.5% overall and 6.8% for under-fives.

Original languageEnglish (US)
Article numbere122559
JournalPloS one
Issue number4
StatePublished - Apr 7 2015

ASJC Scopus subject areas

  • General


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