Paediatric Emergency Triage, Assessment and Treatment (ETAT) – preparedness for implementation at primary care facilities in Malawi

Figures & data

Table 1. Summary of study facilities and participants

		Zomba district		Mchinji district
		Facilities (N = 31)	Providers (N = 338)	Facilities (N = 16)	Providers (N = 193)
Facility type	Dispensary Health centre Rural hospital	3 24 4	26 (8%) 286 (85%) 26 (8%)	2 10 4	14 (7%) 92 (48%) 87 (45%)
In-charge/provider type	Clinical officer Medical assistant Nurse/Midwife HSA Attendant	6 16 9 - -	11 (3%) 32 (9%) 73 (22%) 121 (36%) 101 (30%)	1 11 4 - -	6 (3%) 15 (8%) 32 (17%) 69 (36%) 71 (37%)
Focus group discussions		3		3
Interviews		3		2

Figure 1. Schematic of themes and sub-themes

Table 2. Current triage and referral practices

		Dispensary	Health centre	Rural hospital
Triage conducted	Yes	27 (68%)	279 (74%)	84 (74%)
	No	10 (25%)	66 (17%)	16 (14%)
	Unsure	3 (8%)	33 (9%)	13 (12%)
Staff conducting triage (n = 390)	All staff	16 (59%)	163 (58%)	53 (63%)
	Clinical + non-clinical staff	3 (11%)	49 (18%)	12 (14%)
	Clinical staff only	4 (15%)	34 (12%)	7 (8%)
	Non-clinical staff only	4 (15%)	31 (11%)	12 (14%)
Triage approach (n = 390)	ETAT	2 (7%)	60 (22%)	18 (21%)
	IMCI danger sign	10 (37%)	80 (29%)	17 (20%)
	Child’s appearance	13 (48%)	126 (45%)	46 (55%)
	Caregiver indication	2 (7%)	13 (5%)	3 (4%)
Ever called an ambulance	Yes	9 (23%)	115 (30%)	42 (37%)
	No	31 (78%)	263 (70%)	71 (63%)
Three main reasons for not calling an ambulance (n = 365)		Quicker using own transport	No emergencies	Have their own transport
		Ambulances don’t go there	Quicker using own transport	No emergencies
		Roads too bad	Ambulances don’t go there	No fuel
Three main reason for calling an ambulance (n = 166)		Malaria (78%)	Pneumonia (38%)	Pneumonia (29%)
		Pneumonia (11%)	Malaria (31%)	Anaemia (21%)
		Anaemia (11%)	Anaemia (17%)	Accidents (12%)
Hours for ambulance to arrive (median; IQR)		2 (1.5–3)	3 (2–6)	2 (0.5–4)
Children seen per week (median; IQR)		38 (13–195)	20 (9–100)	25 (10–100)
Severe children seen per week (median; IQR)		5 (2–20)	5 (2–10)	7 (4–20)
Child referrals per week (median; IQR)		2 (1–7)	2 (1–5)	2 (1–3)

Table 3. Linear regression analysis of ETAT knowledge

Variable		Coefficient	95% Confidence interval		p-value
Training	No	Ref
	Yes	2.71	1.99	3.44	<0.001
District	Mchinji	Ref
	Zomba	0.01	−0.48	0.50	0.969
Facility type	Dispensary	Ref
	Health centre	0.17	−0.63	0.97	0.674
	Rural hospital	0.74	−0.18	1.65	0.115
Provider type	Clinical officer	Ref
	Medical assistant	−1.94	−3.31	−0.56	0.006
	Nurse/midwife	−3.26	−4.52	−1.99	<0.001
	HSA	−10.47	−11.74	−9.20	<0.001
	Hospital attendant	−9.97	−11.24	−8.71	<0.001

Figure 2. Proportion of maximum ETAT knowledge score for different healthcare provider types, according to ETAT training

Table 4. Presence of essential ETAT equipment and drugs

	Zomba (N = 31)	Mchinji (N = 16)
Drugs and medications (% in stock, median number and range)
Dextrose 50%	22 (71%; 25, 1–140)	15 (94%; 254, 8–3091)
Adrenaline	16 (52%; 91, 7–1000)	13 (81%; 20, 9–90)
Atropine	5 (16%; 52, 10–172)	14 (88%; 33, 10–80)
Diazepam	29 (90%; 68, 7–160)	13 (81%; 64, 10–122)
Intravenous ceftriaxzone	9 (29%; 21, 4–70)	8 (50%; 91, 4–360)
Intravenous benzylpenicillin	31 (100%; 111, 6–400)	15 (94%; 152, 2–500)
Intravenous gentamicin	31 (100%; 1400, 72–5500)	16 (100%; 2647, 200–4929)
Intravenous artesunate	29 (94%; 229, 12–852)	16 (100%; 1174, 10–7303)
Functional equipment (n, %)
Oxygen	9 (29%)	5 (31%)
Pulse oximeter	4 (13%)	7 (44%)
Resuscitation bag and mask	22 (71%)	8 (50%)
Glucometer	17 (55%)	13 (81%)
Glucose test strips	9 (29%)	10 (63%)
Haemoglobin testing	16 (52%)	3 (19%)
Haemoglobin cuvettes	7 (23%)	3 (19%)

Figure 3. Examples of drug stores and triage rooms. a) Newly built drug store with temperature control in Mchinji District; b) Drug store without temperature control in Zomba District; c) short term stabilisation bed in Mchinji District; d) side-room for triage and stabilisation in Zomba district.