A ranar 9 ga Yuli, 2020, MJami'ar akerere, Makarantar Kiwon Lafiyar Jama'a ta gudanar da wani takamaiman bincike kan yanayin kwayar cutar EMS da kuma kula da matattarar kula da lafiya a Uganda. Sun gano cewa a matakin ƙasa, galibi akwai rashin kayan aiki na motar asibiti, kamar motar ambulan, katako, da kuma ƙarancin ƙwararrun masana.

Kawai 16 (30.8%) na masu samar da asibiti na 52 da aka tantance suna da motocin gaggawa na gaggawa tare da motar asibiti da ake buƙata kayan aiki, magunguna, da ma'aikata don amsawa ga yanayin gaggawa daidai. Wannan shine abin da Jami'ar Makerere ta fahimta bayan binciken ta a cikin Uganda. Wannan yana nufin cewa kusan 70% na ambulances a Yuganda ba su da ƙarfin kula da lafiya a cikin saitin asibiti.

A cikin tushen binciken, sun ba da rahoton cewa Ma'aikatar Lafiya (MoH) ta fahimci buƙatar inganta sabis na motar asibiti. Wannan binciken yana da manufar kafa matsayin asibitocin gaggawa na gaggawa (EMS) da kuma kula da matattarar kula da lafiya a ƙasar Uganda. Sun gudanar da wannan ƙididdigar masu zuwa duka a matakin ƙasa da kuma ƙasa, la'akari da ƙarfin EMS a asibitin kafin-asibiti da kuma wuraren aiki ta amfani da toolungiyar Kula da Lafiya ta Duniya (WHO) na Tsarin Kula da Gaggawa na gaggawa (ECSSA).

Yayinda aka yi wasu 'yan karatuttukan don tantance kulawar asibiti kafin a yi a Kampala [7,8,9], babu wani binciken da ya yi kama da an tantance matsayin EMS da kuma kulawar lafiya a Uganda a matakin ƙasa.

 

Makasudin nazarin da mahimman kayan yau da kullun: rawar da ƙwararrun masana ke ciki da kuma na kayan aikin motar asibiti a Uganda EMS

A matsayin tsarin sabis na gaggawa na likita (EMS), ya kamata kuma sabis na motar asibiti a Yuganda ya kamata ya tsara duk bangarorin kulawa da aka ba marasa lafiya a cikin asibitin kafin-asibiti ko kuma daga asibiti-1 [XNUMX]. Paramedics da EMTs (kuma a cikin rawar direbobin motar asibiti), dole ne su kula da marasa lafiya tare da takamaiman kayan aikin asibiti. Manufar ya kamata ya zama inganta sakamakon sakamako a cikin marasa lafiya da ke da matukar muhimmanci, kamar ta mahaifa, gaggawa na likita, raunin da ya faru, da sauran cututtukan da ke addabar lokaci.

Kulawa kafin asibiti ba filin da ke da iyaka ga fannin kiwon lafiya, yayin da zai iya haɗa da wasu sassa kamar 'yan sanda da na kashe gobara. Bugu da ƙari ga kulawar asibiti, sakamakon haƙuri yana da tasiri sosai ta hanyar kulawa mai mahimmanci da aka bayar a wurin samun lafiya [4]. Rayuwa da murmurewa marasa lafiya sun dogara ne da kasancewar ƙwararrun ma'aikatan kiwon lafiya, da wadatar kayan aikin motar asibiti da suka dace, kamar masu shimfiɗa, kashin baya alluna, tsarin iskar oxygen da sauransu, magunguna, da kayayyaki a cikin mintuna da sa'o'i bayan isowar majiyyaci mai tsananin rashin lafiya a wurin kiwon lafiya [5].

 

EMS a Uganda: kayan aikin motar asibiti da ƙwararrun ƙwararrun ƙwararru ba su da yawa - Girman samfuri da kuma tsarin samfuri

An tsara tsarin kula da lafiyar Uganda a matakai uku:

• asibitocin game da haihuwa na kasar
• asibitocin game da yankin
• general (gundumar) asibitoci

A cikin gundumar, akwai cibiyoyin kiwon lafiya waɗanda ke da madafan iko daban-daban:

Cibiyar Kiwon Lafiya ta I da II: cibiyar kiwon lafiya mafi mahimmanci. Bai dace da yanayin lafiya mai tsanani ba [11];

Cibiyar Kiwon Lafiya II da IV: mafi kyawun sabis na likita.

Jami'ar Makerere ta sami samfurin kayayyakin samarda lafiya a Yuganda daga kamfanin MoH sannan kuma suka bayar da jerin sunayen sassan ta kiwon lafiya. An kara yankuna kiwon lafiya zuwa yankuna 4 na gudanarwa na Yuganda [12] (watau Arewa, Gabas, Yamma, da Tsakiyar) don tabbatar da kowane yanki na gudanarwa a cikin samfurin. A cikin kowane yanki na gudanarwa, ƙungiyar binciken tayi zaɓaɓɓiyar yanki na lafiya guda ɗaya (siffa 1 - ƙasa).

 

Sun nuna niyya da ƙarin ƙarin yankuna uku na kiwon lafiya: Yankin kiwon lafiya na Arua a Yammacin Kogin tunda yana da babban adadin 'yan gudun hijira, wanda zai iya shafar samun dama da kasancewar EMS. Wani kuma shine yankin Karamoja na kiwon lafiya tunda yana da tarihin rikici kuma ya kasance tarihi ya sami nakasa tare da rashin isa ga duk ayyukan zamantakewa. Na ukun shi ne gundumar Kalangala wacce tsibiri take da 84 don haka tana da kalubalen samun damar shigowa da su.

Ofungiyar masu bincike ta Jami’ar Makerere ta tattara dukkanin HCs a cikin yankuna na kiwon lafiya da aka zaɓa ta hanyar mallakar (watau mallakar gwamnati, mai zaman kansa mai riba / ƙungiyar mai zaman kanta (PNFP / NGO), da kuma HCs masu zaman kansu na riba). Ga kowane yanki na kiwon lafiya, sun zaɓi cibiyoyin kiwon lafiya masu riba 2 masu zaman kansu (da, 1 HC IV da 1 HC III), 4 cibiyoyin kiwon lafiya na PN / NGO (watau, 2 HC IV da 2 HC III), da 4 mallakar mallakar gwamnati cibiyoyin kiwon lafiya (watau 2 HC IV da 2 HC III). Inda mai zaman kansa na riba ko PNFP / NGO HC III ko HC IV basu kasance a cikin yankuna da aka zaɓa na lafiya ba, sun cika jigon tare da HC III na gwamnati ko HC IV.

Tsarin samfurin su ya haifar da samfurin samfurin dauke da asibitoci masu nuna juzu'i 7 na yanki, asibitoci 24 (gundumomi), 30 HC IV da 30 HC III. Bugu da kari, Lardin Kamara ana ɗaukarsa yanki ne na musamman saboda matsayinsa na birni babban birni wanda ke da tarin albarkatun kiwon lafiya. Daga cikin RRHs uku (watau Rubaga, Nsambya, da Naguru) a cikin birni, an ƙara RRH (Naguru) a cikin samfurin binciken.

Additionallyari, sun haɗa da policean sanda a matsayin masu ba da kulawa na asibiti kafin galibi su ne farkon masu ba da amsa a wuraren da aka samu hatsarin kuma suna ba da sufuri ga waɗanda abin ya shafa. Binciken bincike ne na kasa baki daya wanda ya hada da yankuna 7 na kiwon lafiya, gundumomi 38 (Fig. 2) [13], wuraren kiwon lafiya 111, da kuma masu samar da asibitin kafin 52. Daga kowane ɗayan gundumomi 38, masu bincike sunyi hira da babban jami'in gundumar, mafi yawan lokuta Jami'in Lafiya na yanki wanda ke yanke shawara game da matakin yanki, da kuma ƙungiyar manyan ma'aikatan 202 waɗanda ke da hannu a cikin EMS da kuma kulawar mahimmin lafiya.

 

Ambulance kayan aiki da ƙwararrun ƙwararru ba a cikin Uganda ba: tarin bayanai

Masu binciken daga Jami'ar Makerere sun dace da kayan aikin tantance tsarin kulawa na gaggawa na WHO [14] wanda Teri Reynolds da sauransu [10] suka kirkiro. Wannan ya taimaka musu wajen tattara bayanai kan EMS a asibitin kafin-lafiya da kuma matakan samar da lafiya. Kayan aiki wanda ya kunshi masu jerin gwanon bincike da kuma jerin tambayoyi, wadanda aka tantance ginshiƙan tsarin kiwon lafiya guda shida: jagoranci da shugabanci; kudade; bayani; ma'aikacin lafiya; kayayyakin likita; da isar da sabis. Sun kuma sake nazarin rahotanni daga nazarin EMS da suka gabata a Uganda [7,8,9] da kuma cikatattun bayanai a cikin godiya saboda muhimmin mai ba da labari fuska don ganawa da wani babban jami'in MOH.

 

 

EMS a Uganda: Sakamakon sakamako akan kayan aikin motar asibiti da ƙwararrun ƙwararru sun rasa

Tebur mai zuwa yana taƙaita sakamakon da aka samu a fannoni daban-daban a matakin ƙasa da na ƙasa. Ƙarin cikakkun sakamako a hanyoyin haɗin a ƙarshen labarin.

 

Bayanai game da EMS a Uganda: tattaunawa

Uganda ta juya baya ga karancin manufofin kasa, jagorori, da ka'idoji a fagen likitancin gaggawa. Wannan rashi ya kasance mai ma'ana ga kowane ɓangaren fannin kiwon lafiya: tallafi; kayayyakin likita, da daidaituwa.

Yankunan gaggawa a cikin wuraren kiwon lafiya basu da kayan aikin asibiti na asali da magunguna duka biyu don saka idanu da kuma kula da yanayin likita na gaggawa. Wannan mummunan rashin kayan aiki da magunguna an lura dashi a dukkan matakan tsarin kiwon lafiya. Kodayake, wuraren kiwon lafiya masu zaman kansu da ambulances sun kasance sun fi dacewa da na gwamnati. Iyakantaccen samuwan aiki da kayan aikin motar asibiti don ba da amsa ga yanayin rashin lafiyar gaggawa yana nufin marasa lafiya suna da karancin kulawa a cikin sashin kafin asibitin, sannan kuma jigilar su zuwa wuraren kiwon lafiya waɗanda kawai ke da wadataccen kayan aikin sarrafa abubuwan haɗari.

Ambulance sabis na fama da mummunan kayan aiki, daidaituwa da sadarwa. Aƙalla 50% na masu samar da EMS da aka yi hira da su sun ba da sanarwar cewa ba su taɓa sanar da wuraren kiwon lafiya ba kafin canja wurin abubuwan gaggawa. Wannan asibitocin, gami da asibitocin Ishara da yankin, basu da EMS sau 24 a rana. Lallai, mahauta da dangi galibi sune kawai ke taimakon marasa lafiya a likitancin. Kuma motocin 'yan sanda masu ababen hawa sun zama ruwan dare (don 36 daga cikin masu samar da 52) yanayin jigilar marasa lafiya da ke buƙatar kulawa ta gaggawa.

Binciken ya bayyana motar asibiti a matsayin motar gaggawa ta samar da jigilar gaggawa da kulawa yayin da suke cikin filin kafin asibitin, hakan na nuna cewa yawancin masu ba da agajin asibiti ba su da motar asibiti, amma sun kasance masu ba da agajin gaggawa. Haka kuma, a kowane matakin, akwai shaidar rashin isassun kudade don EMS.

Iyakokin wannan binciken sune kurakurai na ma'auni daga dogaro ga rahoton kai don wasu sakamakon (misali, amfani da bayanai don tsarawa). Koyaya, yawancin mahimman sakamakon (kasancewa da kuma aiki na samfuran likita) a cikin binciken an auna su ta hanyar sa ido kai tsaye. Sakamakon binciken masu binciken ya ba da tabbaci ga waɗanda daga wasu nazarin ta amfani da irin wannan hanya wanda ya gano rashin jagoranci, dokoki da kudade a matsayin manyan shinge na ci gaban EMS a cikin ƙasashe masu tasowa [16].

Wanda aka bayar da rahoton a wannan labarin bincike ne na kasa kuma saboda haka ana iya samar da abubuwan da za ayi amfani da su ga daukacin Yuganda. Hakanan za'a iya samar da binciken ga sauran ƙasashe masu karamin karfi da kuma na matsakaitan ƙasa a Afirka waɗanda ba su da tsarin EMS [1] kuma don haka, za a iya amfani da su don jagorantar ƙoƙarin inganta tsarin EMS a cikin waɗannan saitunan.

 

A ƙarshe ...

Kasar Uganda tana da tsarin hade-hade da tsari da yawa wanda kuma marasa lafiya za su iya zuwa neman magani. Koyaya, daga binciken da ke sama mutane da yawa na iya tambaya 'Shin Uganda tana da EMS?'. Dole ne mu fayyace cewa an gudanar da wannan binciken ne a lokacin da babu manufar EMS, babu ka'idoji, da kuma daidaitaccen daidaituwa a matakan ƙasa da ƙasa.

Dangane da binciken Jami'ar Makerere, saboda haka, yana da ma'ana mai ma'ana don yanke hukuncin cewa, a zahiri, babu EMS, amma akwai wasu muhimman abubuwan da ake iya sake tsara su a matsayin farawa don kafa tsarin. Wannan zai ba da dalilin dalilin motar motar asibiti da ƙarancin ƙwararrun ma'aikata. Koyaya, akwai wani tsari da ake aiwatarwa don haɓaka manufofi da ƙa'idodi don kafa EMS.

 

nassoshi

1. Mistovich JJ, Hafen BQ, Karren KJ, Werman HA, Hafen B. Kulawar gaggawa na prehospital: Brady prentice hall hall; 2004.
2. Mould-Millman NK, Dixon JM, Sefa N, Yancey A, Hollong BG, Hagahmed M, et al. Tsarin tsarin aiyukan kiwon lafiya na gaggawa (EMS) a Afirka. Prehosp Bala'i Med. 2017; 32 (3): 273-83.
3. Plummer V, Boyle M. tsarin EMS a cikin ƙasashe masu shigowa na ƙananan-matsakaici: nazarin bugu. Prehosp Bala'i Med. 2017; 32 (1): 64-70.
4. Hirshon JM, Risko N, Calvello EJ, SSd R, Narayan M, Theodosis C, et al. Tsarin kiwon lafiya da ayyuka: rawar da ke cikin kulawa. Bull Lafiya na Duniya. 2013; 91: 386-8.
5. Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Jagororin don kulawa da rauni mai mahimmanci. Geneva: Kungiyar Lafiya ta Duniya; 2004.
6. Kobusingye OC, Hyder AA, Bishai D, Joshipura M, Hicks ER, Mock C. ayyukan likita na gaggawa. Dis Control Ayyukan Kasashen Dev. 2006; 2 (68): 626-8.
7. Bayiga Zziwa E, Muhumuza C, Muni KM, Atuyambe L, Bachani AM, Kobusingye OC. Raunin zirga-zirgar ababen hawa a cikin Yuganda: lokacin kulawa da asibiti kafin lokacin asibiti tun daga hatsarin zuwa asibiti da wasu dalilai da 'yan sanda na Uganda suka yi. Int J Inj Contr Safari mai taken. 2019; 26 (2): 170-5.
8. Mehmood A, Paichadze N, Bayiga E, et al. 594 Bunkasa ci gaba da gwajin gwaji na kayan aiki na gwaji na gaggawa don kula da asibiti kafin a asibiti a Kampala, Uganda. Yin rigakafin Rauni. 2016; 22: A213.
9. Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Rashin rauni da kuma karfin da suka shafi kulawar gaggawa na Prehospital ga wadanda hatsarin ya ritsa da su a kan titin babban birni na Kamaru: binciken yanki. BMC Emerg Med. 2017; 17 (1): 29.
10. Reynolds TA, Sawe H, Rubiano AM, Do Shin S, Wallis L, Mock CN. Systemsarfafa tsarin kiwon lafiya don ba da kulawa ta gaggawa. Mahimmin Lafiyar Cututtuka Cutar: Inganta Lafiya da Rage Talauci bugu na 3: Babban bankin kasa da kasa don sake ginawa da bunƙasa / Bankin Duniya; 2017.
11. Acup C, Bardosh KL, Picozzi K, Waiswa C, Welburn SC. Abubuwanda ke haifar da sahihan ido ga T. b. rhodesiense ɗan adam african trypanosomiasis a cikin Uganda. Acta Trop. 2017; 165: 230–9.
12. Wang H, Kilmartin L. Kwatanta halayyar zaman jama'a da birane a cikin Uganda: basira daga amfani da sabis na murya ta hannu. J Urban Technol. 2014; 21 (2): 61-89.
13. QGIS Development Team. Tsarin Bayanan Bayanan Yanayi na QGIS 2018. Akwai shi daga: http://qgis.osgeo.org.
14. Hukumar Lafiya Ta Duniya. Gaggawa da gaggawa kulawa Geneva, Switzerland. 2018. Ana samun su daga: https://www.who.int/emer gaggawacare/activities/en/.
15. Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, Borriello G. Buɗe kayan aikin bayanai: kayan aikin gina sabis na bayanai don yankuna masu tasowa. A cikin: Ayyukan Taro na 4 na ACM / IEEE na Duniya akan Bayanai da Fasahar Sadarwa da Ci gaban Kasa. London: ACM; 2010. p. 1-12.
16. Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, Rivara F. kimantawa game da matsayin kulawar prehospital a cikin kasashe 13 masu karamin karfi. Kulawa da Prehosp Emerg. 2012; 16 (3): 381-9.

 

AUTHORS

Albert Ningwa: Ma'aikatar Kula da Cututtuka da Kiwon Lafiyar muhalli, Makarantar Makarantar Likitoci ta Jami’ar Makerere, Kampala, Uganda

Kennedy Mun: Ma'aikatar Epidemiology, Jami'ar Washington, Seattle, WA, Amurka

Frederick Oporia: Ma'aikatar Kula da Cututtuka da Kiwon Lafiyar muhalli, Makarantar Makarantar Likitoci ta Jami’ar Makerere, Kampala, Uganda

Yusufu Kalanzi: Ma'aikatar Lafiya ta gaggawa, Ma'aikatar Lafiya, Kampala, Uganda

Esther Bayiga Zziwa: Ma'aikatar Kula da Cututtuka da Kiwon Lafiyar muhalli, Makarantar Makarantar Likitoci ta Jami’ar Makerere, Kampala, Uganda

Claire Biribawa: Sashen Kula da Cututtuka da Kiwon Lafiyar muhalli, Makarantar Makarantar Likitoci ta Jami’ar Makerere, Kampala, Uganda

Zaitun Kobusingye: Ma'aikatar Kula da Cututtuka da Kiwon Lafiyar muhalli, Makarantar Makarantar Likitoci ta Jami’ar Makerere, Kampala, Uganda

 

 

KARANTA ALSO

EMS A cikin Yuganda - Yankin motar asibiti ta Uganda: Lokacin da Passion ya hadu da Yin Hadaya

Yankin Uganda Don Ciki Tareda Boda-Boda, Takarar Harajin Mota Kamar Ambulances

Uganda: Sabbin Ambulances 38 Na Ziyarar Paparoma Francis

 

 

SOURCES

BMS: BioMed ta Tsakiya - Matsayin yanayin kula da lafiya na gaggawa da kula da matattarar kula da lafiya a Uganda: binciken daga Binciken Sashe na Kasa-Kasa

Ƙwararrun mutane: Halin ayyukan gaggawa na likita da kula da matattarar kula da lafiya a Uganda: binciken daga Binciken Sashe na Crossasa

Makarantar Kwalejin Kiwon Lafiyar Jama'a na Kimiyyar Kiwon Lafiya, Jami'ar Makerere

 

WHO: kulawa ta gaggawa