Lub Xya hli ntuj 9, 2020, Makerere University, Tsev Kawm Ntawv Kev Noj Qab Haus Huv tau ua ib qho kev tshawb fawb tshwj xeeb ntawm lub xeev EMS thiab kev saib xyuas mob hnyav hauv Uganda. Lawv pom tias nyob rau hauv sub-national theem, feem ntau yog tsis muaj tsheb thauj neeg mob cov cuab yeej, xws li tsheb thauj neeg mob stretchers, spinal boards, thiab kuj tsis muaj kev cob qhia cov tub txawg.

Tsuas yog 16 (30.8%) ntawm 52 lub tsev kho mob ua ntej tau soj ntsuam muaj cov tsheb xwm txheej ceev nrog lub tsheb thauj neeg mob xav tau cov khoom, tshuaj, thiab cov neeg ua haujlwm los teb rau qhov xwm txheej kub ntxhov kom raug. Nov yog qhov Makerere University nkag siab tom qab nws daim ntawv ntsuam xyuas thoob plaws Uganda. Qhov no txhais tau tias yuav luag 70% ntawm ambulances hauv Uganda tsis muaj peev xwm kho mob hauv tsev kho mob ua ntej.

Hauv keeb kwm ntawm kev tshawb fawb, lawv tau tshaj tawm tias Ministry of Health (MoH) tau lees paub qhov xav tau los txhim kho cov kev pabcuam tsheb thauj neeg mob. Txoj kev tshawb no muaj lub hom phiaj los tsim cov xwm txheej ntawm kev pabcuam khomob kub ntxhov (EMS) thiab kev saib xyuas mob hnyav hauv Uganda. Lawv tau ua qhov kev ntsuam xyuas hauv qab no ob qho tib si hauv lub tebchaws thiab hauv qab teb chaws, txiav txim siab txog EMS muaj peev xwm ntawm qib tsev kho mob ua ntej thiab chaw nyob siv lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv (WHO) Kev Ntsuam Xyuas Kev Kho Mob Kub Ceev (ECSSA) cov cuab yeej.

Txawm hais tias ob peb txoj kev tshawb fawb tau ua tiav los ntsuas kev saib xyuas ua ntej hauv tsev kho mob hauv Kampala [7,8,9], tsis muaj kev tshawb fawb zoo li tau ua los ntsuas qhov xwm txheej ntawm EMS thiab kev saib xyuas mob hnyav hauv Uganda ntawm lub tebchaws.

 

Lub hom phiaj ntawm txoj kev kawm thiab cov hauv paus ntsiab lus: lub luag haujlwm ntawm cov kws tshaj lij thiab cov khoom siv tsheb thauj neeg mob hauv Uganda EMS

Raws li qhov kev pabcuam khomob xwm txheej ceev (EMS), kuj tseem muaj cov kev pabcuam tsheb thauj neeg mob hauv Uganda yuav tsum npaj txhua yam ntawm kev saib xyuas rau cov neeg mob hauv tsev kho mob ua ntej lossis tawm hauv tsev kho mob [1]. Cov kws kho mob thiab EMTs (tseem nyob rau hauv lub luag haujlwm ntawm cov neeg tsav tsheb thauj neeg mob), yuav tsum tswj cov neeg mob nrog cov khoom siv tsheb thauj neeg mob tshwj xeeb. Lub hom phiaj yuav tsum yog kev txhim kho cov txiaj ntsig ntawm cov neeg mob uas muaj mob hnyav, xws li obstetric, kho mob xwm txheej ceev, raug mob hnyav, thiab lwm yam mob hnyav rau lub sijhawm.

Kev saib xyuas ua ntej hauv tsev kho mob tsis yog thaj chaw tshwj xeeb rau kev noj qab haus huv, thaum nws tuaj yeem koom nrog lwm cov haujlwm xws li tub ceev xwm thiab chaw tua hluav taws. Ntxiv nrog rau kev saib xyuas ua ntej hauv tsev kho mob, cov txiaj ntsig ntawm tus neeg mob tau cuam tshuam zoo heev los ntawm kev kho mob hnyav xa mus rau ntawm qhov chaw txais kev noj qab haus huv [4]. Cov neeg mob muaj sia nyob thiab rov qab los yog nyob ntawm qhov muaj cov neeg ua haujlwm kho mob uas tsim nyog, thiab muaj cov khoom siv tsheb thauj neeg mob uas tsim nyog, xws li stretchers, tus hlwb boards, oxygen system thiab lwm yam, tshuaj, thiab khoom siv hauv feeb thiab teev tom qab tuaj txog ntawm tus neeg mob hnyav ntawm lub chaw kho mob [5].

 

EMS hauv Uganda: cov khoom siv tsheb thauj neeg mob thiab cov kws tshaj lij tsis muaj - Cov qauv loj thiab qauv qauv

Uganda kev saib xyuas kev noj qab haus huv tau teeb tsa ua peb theem tseem ceeb:

• cov tsev kho mob hauv teb chaws
• cov tsev kho mob hauv cheeb tsam xa mus
• tsev kho mob general (koog tsev kawm ntawv).

Hauv cheeb tsam, muaj cov chaw kho mob uas muaj peev xwm sib txawv:

Health Center I thiab II: qhov chaw kho mob yooj yim tshaj plaws. Tsis haum rau mob hnyav [11];

Lub Chaw Kho Mob II thiab IV: cov kev pabcuam khomob zoo tshaj plaws.

Lub Tsev Kawm Qib Siab Makerere tau txais cov qauv piv txwv ntawm txhua qhov chaw kho mob hauv Uganda los ntawm MoH thiab stratified cov npe los ntawm cheeb tsam kev noj qab haus huv. Cov cheeb tsam kev noj qab haus huv tau muab ua pawg ntxiv rau hauv Uganda 4 thaj chaw tswj hwm thaj chaw [12] (piv txwv li, North, East, West, thiab Central) kom ntseeg tau tias txhua cheeb tsam thaj chaw tswj hwm tau sawv cev hauv cov qauv. Hauv txhua cheeb tsam hauv cheeb tsam, pawg neeg tshawb fawb tau xaiv ib cheeb tsam kev noj qab haus huv (Daim duab 1 - hauv qab).

 

Lawv lub hom phiaj suav nrog peb cheeb tsam kev noj qab haus huv ntxiv: Arua cheeb tsam kev noj qab haus huv hauv West Nile vim nws muaj cov neeg tawg rog coob, uas tuaj yeem cuam tshuam txog kev nkag mus thiab muaj EMS. Lwm qhov yog Karamoja cheeb tsam kev noj qab haus huv txij li nws muaj keeb kwm ntawm kev tsis sib haum xeeb thiab muaj keeb kwm tsis zoo nrog kev nkag mus rau txhua qhov kev pabcuam hauv zej zog. Qhov thib peb yog Kalangala koog tsev kawm ntawv uas yog tsim los ntawm 84 Islands tuaj thiab yog li ntawd muaj kev sib tw thauj mus los tshwj xeeb.

Pab pawg neeg tshawb fawb hauv University of Makerere tau muab txhua pawg HCs hauv cov cheeb tsam kev noj qab haus huv xaiv los ntawm kev ua tswv cuab (piv txwv li, tsoomfwv cov tswv, cov koom haum ntiag tug tsis muaj txiaj ntsig / tsis yog tsoomfwv (PNFP / NGO), thiab HC ntiag tug rau cov txiaj ntsig). Rau txhua cheeb tsam kev noj qab haus huv, lawv xaiv 2 lub chaw kho mob ntiag tug (piv txwv li, 1 HC IV thiab 1 HC III), 4 PNFP/NGO cov chaw noj qab haus huv (piv txwv li, 2 HC IV thiab 2 HC III), thiab 4 lub tseem fwv muaj. cov chaw kho mob (xws li, 2 HC IV thiab 2 HC III). Qhov chaw uas tsis muaj nyiaj txiag ntiag tug lossis PNFP/NGO HC III lossis HC IV tsis muaj nyob rau hauv cov cheeb tsam kev noj qab haus huv uas tau xaiv, lawv tau sau lub qhov (s) nrog tsoomfwv HC III lossis HC IV.

Lawv cov tswv yim ua piv txwv tau ua rau cov qauv loj uas muaj 7 lub tsev kho mob xa mus hauv cheeb tsam, 24 lub tsev kho mob dav dav (koog tsev kawm ntawv), 30 HC IV thiab 30 HC III. Tsis tas li ntawd, Kampala District tau raug suav hais tias yog ib cheeb tsam tshwj xeeb vim nws qhov xwm txheej yog lub nroog lub nroog uas muaj kev noj qab haus huv ntau. Tawm ntawm peb RRHs (ie, Rubaga, Nsambya, thiab Naguru) nyob rau hauv lub nroog, ib tug RRH (Naguru) tau ntxiv rau cov qauv kawm.

Tsis tas li ntawd, lawv suav nrog tub ceev xwm ua cov chaw kho mob ua ntej vim tias lawv feem ntau yog thawj tus neeg teb rau qhov xwm txheej raug mob thiab muab kev thauj mus los rau cov neeg raug tsim txom. Txoj kev tshawb fawb no yog ib qho kev tshawb fawb thoob teb chaws uas suav nrog 7 cheeb tsam kev noj qab haus huv, 38 cheeb tsam (Daim duab 2) [13], 111 chaw kho mob, thiab 52 lub tsev kho mob ua ntej. Los ntawm txhua lub nroog 38, cov kws tshawb fawb tau xam phaj ib tus tub ceev xwm hauv nroog loj, feem ntau yog Tus Thawj Saib Xyuas Kev Noj Qab Haus Huv Hauv Cheeb Tsam uas yog tus txiav txim siab hauv cheeb tsam, thiab tag nrho ntawm 202 tus neeg ua haujlwm tseem ceeb koom nrog EMS thiab kev saib xyuas mob hnyav.

 

Cov khoom siv tsheb thauj neeg mob thiab cov kws tshaj lij tsis muaj nyob hauv Uganda: kev sau cov ntaub ntawv

Cov kws tshawb fawb los ntawm Makerere University tau hloov kho WHO Emergency Care Systems soj ntsuam cov cuab yeej [14] tsim los ntawm Teri Reynolds thiab lwm tus [10]. Qhov no tau pab lawv khaws cov ntaub ntawv ntawm EMS ntawm qib tsev kho mob ua ntej thiab chaw kho mob. Cov cuab yeej suav nrog cov ntawv txheeb xyuas thiab cov qauv nug, uas ntsuas rau 7,8,9 lub hauv paus kev noj qab haus huv: kev coj noj coj ua thiab kev tswj hwm; nyiaj txiag; cov ntaub ntawv; cov neeg ua haujlwm noj qab haus huv; cov khoom kho mob; thiab kev pabcuam. Lawv kuj tau tshuaj xyuas cov ntawv ceeb toom los ntawm EMS cov kev tshawb fawb yav dhau los hauv Uganda [XNUMX] thiab tau sau qhov khoob hauv cov ntaub ntawv ua tsaug rau cov neeg qhia tseem ceeb ntawm lub ntsej muag mus ntsib kev sib tham nrog MOH cov thawj coj loj.

 

 

EMS hauv Uganda: Cov txiaj ntsig tau piav qhia ntawm cov khoom siv tsheb thauj neeg mob thiab cov kws cob qhia tsis muaj

Cov lus hauv qab no qhia txog cov txiaj ntsig tau pom nyob rau hauv ntau qhov chaw ob qho tib si ntawm lub tebchaws thiab sub-national theem. Cov ntsiab lus ntxaws ntxiv ntawm qhov txuas ntawm qhov kawg ntawm kab lus.

 

Cov ntaub ntawv ntawm EMS hauv Uganda: kev sib tham

Uganda tau dhau los ua qhov tsis txaus ntawm lub tebchaws txoj cai, cov lus qhia, thiab cov qauv hauv kev kho mob xwm txheej ceev. Qhov kev tsis txaus no yog xav txog ntawm txhua qhov haujlwm ntawm kev kho mob: nyiaj txiag; cov khoom kho mob, thiab kev sib koom tes.

Cov cheeb tsam xwm txheej kub ntxhov hauv cov chaw kho mob tsis muaj cov cuab yeej siv tsheb thauj neeg mob thiab cov tshuaj uas yooj yim tshaj plaws los saib xyuas thiab kho ntau yam mob xwm txheej ceev. Qhov kev tsis txaus siab ntawm cov cuab yeej siv thiab cov tshuaj no tau pom nyob rau txhua theem ntawm kev noj qab haus huv. Txawm li cas los xij, cov chaw kho mob ntiag tug thiab lub tsheb thauj neeg mob tau zoo dua qub dua li tsoomfwv. Kev txwv tsis pub muaj thiab ua haujlwm ntawm cov cuab yeej tsheb thauj neeg mob los teb rau cov xwm txheej kub ntxhov txhais tau tias cov neeg mob tau txais kev saib xyuas tsawg heev nyob rau theem ua ntej tsev kho mob, thiab tom qab ntawd raug thauj mus rau cov chaw kho mob uas tsuas yog me ntsis zoo dua los tswj lawv cov xwm txheej mob.

Kev pabcuam tsheb thauj neeg mob tau plagued los ntawm cov khoom siv tsis zoo, kev sib koom tes thiab kev sib txuas lus. Tsawg kawg yog 50% ntawm EMS cov chaw muab kev xam phaj tau tshaj tawm tias lawv tsis tau ceeb toom rau cov chaw kho mob ua ntej hloov mus rau qhov xwm txheej ceev. Cov tsev kho mob ntawd, suav nrog cov tsev kho mob xa mus hauv cheeb tsam, tsis muaj EMS muaj 24 ha hnub. Qhov tseeb tiag, cov neeg sawv cev thiab cov txheeb ze feem ntau yog tib leeg los pab kho mob. Thiab cov tub ceev xwm saib xyuas tsheb yog qhov ntau tshaj plaws (rau 36 ntawm 52 tus neeg muab kev pabcuam) kev thauj neeg mob xav tau kev saib xyuas xwm txheej ceev.

Txoj kev tshawb no tau txhais lub tsheb thauj neeg mob raws li lub tsheb thauj neeg mob ceev uas muab kev thauj mus los thaum muaj xwm txheej ceev thiab kev saib xyuas thaum nyob hauv qhov chaw ua ntej tsev kho mob, nws txhais tau tias feem ntau ntawm cov chaw kho mob ua ntej tsis muaj tsheb thauj neeg mob, tab sis lawv yog cov chaw kho mob thaum muaj xwm ceev. Ntxiv mus, nyob rau txhua theem, muaj pov thawj ntawm tsis txaus nyiaj txiag rau EMS.

Cov kev txwv ntawm txoj kev tshawb no yog kev ntsuas qhov yuam kev los ntawm kev cia siab rau ntawm tus kheej daim ntawv tshaj tawm rau qee qhov tshwm sim (xws li, cov ntaub ntawv siv rau kev npaj). Txawm li cas los xij, feem ntau ntawm cov txiaj ntsig tseem ceeb (muaj thiab ua haujlwm ntawm cov khoom kho mob) hauv txoj kev tshawb fawb tau ntsuas los ntawm kev soj ntsuam ncaj qha. Cov kws tshawb fawb cov kev tshawb pom tau lees paub cov neeg los ntawm lwm cov kev tshawb fawb uas siv cov txheej txheem zoo sib xws uas pom tias tsis muaj kev coj noj coj ua, kev cai lij choj thiab nyiaj txiag los ua qhov cuam tshuam tseem ceeb rau kev txhim kho EMS hauv cov teb chaws tsim [16].

Ib qho uas tau tshaj tawm hauv tsab xov xwm no yog kev tshawb fawb hauv tebchaws thiab yog li qhov kev tshawb pom tuaj yeem nthuav dav rau tag nrho Uganda. Cov kev tshawb pom kuj tseem tuaj yeem nthuav dav rau lwm lub tebchaws tau nyiaj tsawg thiab nruab nrab hauv tebchaws Africa uas tsis muaj EMS tshuab [1] thiab tuaj yeem siv los qhia kev siv zog txhawm rau txhim kho EMS systems hauv cov chaw no.

 

Hauv kev xaus…

Uganda muaj ntau theem ntawm cov chaw kho mob uas cov neeg mob tuaj yeem mus kho mob. Txawm li cas los xij, los ntawm kev tshawb pom saum toj no ntau tus tuaj yeem nug 'Uganda puas muaj EMS?'. Peb yuav tsum qhia meej tias txoj kev tshawb fawb no tau ua nyob rau lub sijhawm uas tsis muaj EMS txoj cai, tsis muaj cov qauv, thiab kev sib koom ua haujlwm tsis zoo ntawm lub tebchaws thiab hauv qab teb chaws.

Raws li Makerere University qhov kev tshawb pom, nws, yog li ntawd, zoo li ceev faj los txiav txim siab tias muaj, qhov tseeb, tsis muaj EMS, tab sis muaj ntau yam tseem ceeb nyob rau hauv qhov chaw uas tuaj yeem hloov kho raws li qhov pib ntawm kev tsim lub system. Qhov no yuav piav qhia txog vim li cas cov khoom siv tsheb thauj neeg mob thiab cov neeg ua haujlwm raug cob qhia tsis txaus. Txawm li cas los xij, muaj ib txoj hauv kev los tsim cov cai thiab cov lus qhia rau kev tsim EMS.

 

ua tim khawv

1. Mistovich JJ, Hafen BQ, Karren KJ, Werman HA, Hafen B. Prehospital Emergency Care: Brady prentice Hall noj qab haus huv; Xyoo 2004.
2. Mould-Millman NK, Dixon JM, Sefa N, Yancey A, Hollong BG, Hagahmed M, et al. Lub xeev cov kev pabcuam khomob kub ntxhov (EMS) hauv tebchaws Africa. Prehosp Disaster Med. 2017; 32(3): 273–83.
3. Plummer V, Boyle M. EMS systems nyob rau hauv qis-middle lub teb chaws cov nyiaj tau los: cov ntaub ntawv tshuaj xyuas. Prehosp Disaster Med. 2017; 32(1):64–70.
4. Hirshon JM, Risko N, Calvello EJ, SSd R, Narayan M, Theodosis C, et al. Cov kab ke kev noj qab haus huv thiab kev pabcuam: lub luag haujlwm ntawm kev saib xyuas mob hnyav. Bull World Health Organ. 2013; 91:386–8.
5. Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Cov lus qhia rau kev kho mob tseem ceeb. Geneva: World Health Organization; Xyoo 2004.
6. Kobusingye OC, Hyder AA, Bishai D, Joshipura M, Hicks ER, Mock C. Kev pab kho mob xwm txheej ceev. Dis Control Priorities Dev Lub Tebchaws. 2006; 2(68:626–8.
7. Bayiga Zziwa E, Muhumuza C, Muni KM, Atuyambe L, Bachani AM, Kobusingye OC. Txoj kev raug mob hauv Uganda: lub sijhawm saib xyuas hauv tsev kho mob ua ntej lub sijhawm los ntawm kev sib tsoo mus rau tsev kho mob thiab lwm yam los ntawm Uganda tub ceev xwm. Int J Inj Contr Kev Txhawb Nqa. 2019; 26(2):170–5.
8. Mehmood A, Paichadze N, Bayiga E, et al. 594 Kev txhim kho thiab kev sim-kuaj ntawm cov cuab yeej ntsuas nrawm rau kev saib xyuas ua ntej hauv tsev kho mob hauv Kampala, Uganda. Tiv thaiv kev raug mob. 2016; 22: A213.
9. Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Tsis muaj zog thiab muaj peev xwm cuam tshuam rau Prehospital kev saib xyuas xwm txheej ceev rau cov neeg raug tsim txom ntawm txoj kev tsheb sib tsoo hauv cheeb tsam Kampala loj dua: kev kawm hla ntu. BMC Emerg Med. Xyoo 2017; 17(1): 29.
10. Reynolds TA, Sawe H, Rubiano AM, Do Shin S, Wallis L, Mock CN. Txhim kho cov kab ke kev noj qab haus huv los muab kev kho mob xwm txheej ceev. Kev Tswj Kab Mob Ua Ntej: Txhim Kho Kev Noj Qab Haus Huv thiab Txo Kev Txom Nyem 3rd edition: The International Bank for Reconstruction and Development/The World Bank; 2017.
11. Acup C, Bardosh KL, Picozzi K, Waiswa C, Welburn SC. Cov xwm txheej cuam tshuam rau kev soj ntsuam passive rau T. b. rhodesiense tib neeg African trypanosomiasis hauv Uganda. Acta Trop. 2017; 165:230–9.
12. Wang H, Kilmartin L. Sib piv cov neeg nyob deb nroog thiab nroog kev coj noj coj ua thiab kev lag luam hauv Uganda: kev nkag siab los ntawm kev siv lub suab siv xov tooj. J Urban Technol. 2014; 21(2):61–89.
13. QGIS Development Team. QGIS Geographic Information System 2018. Muaj los ntawm: http://qgis.osgeo.org.
14. Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Thoob Ntiaj Teb. Kev kho mob xwm txheej ceev thiab raug mob Geneva, Switzerland. 2018. Muaj los ntawm: https://www.who.int/emergencycare/activities/en/.
15. Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, Borriello G. Qhib cov ntaub ntawv cov khoom siv: cov cuab yeej los tsim cov ntaub ntawv kev pabcuam rau kev tsim cov cheeb tsam. Hauv: Kev Ua Haujlwm ntawm 4th ACM / IEEE International Conference on Information and Communication Technologies and Development. London: ACM; 2010. p. 1–12.
16. Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, Rivara F. Kev soj ntsuam ntawm cov xwm txheej ntawm kev saib xyuas ua ntej hauv 13 lub teb chaws tau nyiaj tsawg thiab nruab nrab. Prehosp Emerg Care. 2012; 16(3):381–9.

 

TSO CAI

Albert Ningwa: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

Kennedy Muni: Department of Epidemiology, University of Washington, Seattle, WA, USA

Frederick Oporia: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

Joseph Kalanzi: Department of Emergency Medical Services, Ministry of Health, Kampala, Uganda

Esther Bayiga Zziwa: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

Claire Biribawa: XNUMX Lab tus kiv cua tos koj rau Webtalk! Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

Olive Koob: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

 

 

NYEEM ALSO

EMS Hauv Uganda - Uganda Kev Pabcuam Tsheb thauj neeg mob: Thaum Mob siab rau ntsib kev txi

Uganda Kev Cev Xeeb Tub Nrog Boda-Boda, Cov Tsheb Tsav Tsheb Tsav Tsheb Siv Raws li Tsheb Thauj Mus Los

Uganda: 38 Lub Tsheb Thauj Mus Los Tshiab Rau Kev Mus Los Ntawm Pope Francis

 

 

SOURCES

BMS: BioMed Central - Lub xeev cov kev pabcuam khomob kub ntxhov thiab kev saib xyuas mob hnyav hauv Uganda: kev tshawb pom los ntawm National Cross-Sectional Survey

Peer Reviews: Lub xeev cov kev pabcuam khomob kub ntxhov thiab kev saib xyuas mob hnyav hauv Uganda: kev tshawb pom los ntawm National Cross-Sectional Survey

Tsev kawm ntawv ntawm Public Health College ntawm Health Sciences, Makerere University

 

WHO: Kev saib xyuas xwm txheej ceev