Prioritization of Critically Unwell Children in Low Resource Primary Healthcare Centers in Cape Town, South Africa: Implementation and Clinical Outcomes
Delays in care significantly contribute to the mortality of children in low resource settings. In one such location, Cape Town, South Africa, where Primary Health Clinics (PHCs) are responsible for evaluating children, delayed recognition and referral is a key contributor to the fact that 10% of them die before age five.1 Despite the proven benefit of triage tools, such as the World Health Organization's Emergency Triage and Assessment Tool (ETAT), they are unused in PHCs in Cape Town due to resource constraints. The Pathways to Care Study (PTCS) team from the University of Cape Town, with the assistance of faculty from Johns Hopkins (JHU), have created and are validating a modified ETAT designed to screen sick children in PHCs in Cape Town. We will implement the tool in 80 clinics in the region and I will assist in the implementation of the tool in a subset of clinics, and evaluate the impact of the triage tool on longitudinal outcomes in critically unwell children. The study is a one-year prospective chart review that will compare outcomes in children referred to Red Cross War Memorial Children's Hospital from PHCs with and without the screening tool. We hypothesize that screening will result in timelier referral to definitive care, and thus improved outcomes in this vulnerable population.