Evaluation of the preparedness of the children’s emergency rooms (CHER) in Southern Nigeria for service delivery

Abstract

Background: The Children Emergency Room (CHER) is the first point of call for many sick children. A significant proportion of childhood and under five deaths in tertiary institutions takes place in the CHER. There is thus need for a high level skilled manpower and infrastructure in the CHER in readiness for service delivery.
Objective: To assesses the preparedness of the children emergency room in tertiary institutions in southern Nigeria to successful management of children presenting to the emergency rooms.
Methods: This study was a cross sectional, descriptive multicentre study carried out among nine Tertiary Hospitals in Southern Nigeria. Three tertiary hospitals were randomly selected from each of the three Geo political zones (South-South, South- East and South -West) in Southern Nigeria. A structured questionnaire was used to collect data about the Children Emergency Rooms in these hospitals. The obtained data was entered and analysed using SPSS version 21 and is presented as table.
Results: All the centres have an emergency room. The number of doctors in CHER ranged from 7 to 22 while the number of nurses ranged from 10 to 24 persons with a nurse: bed ratio of 1:3-15. In all the centres, the CHER had a side laboratory, well stocked emergency drug shelf, pulse oximeters, oxygen cylinders, electrical and manual suction machines, ambu bags and nebulizers. However, none of the centres has functional manual defibrillator or an Automated External Defibrillator (AED). In 5 (55.6%) of the studied centres, the doctors and nurses have training on emergency triage. Also 5 (55.6%) centres have doctors with certification in emergency care, but none of the nurses in all the centres have any certification in emergency care. Three (33.3%) centres had staff trained with skills on the use of AED while in 4(44.4%) centres they were skilled on the use of manual defibrillators. All the centres have a waiting area for patients’ relatives but only one (11.1%) has a television installed. All the CHERs have toilet facilities for patients relatives but only 5 (55.6%) have bathrooms. Running water is regularly available in the toilets of only 4 (44.4%) of the centres.
Conclusion/Recommendation: We conclude that limitation abounds with regards to personnel, high technology infrastructure, personnel skill and patient friendly infrastructure. It is recommended that concerted efforts should be made by the government and all key players to make available the necessary equipment and facilities and ensure that health personnel acquire the necessary skills so that the standard of practice in our tertiary hospitals will be comparable to international best practices.