Emergency care capabilities in the Kingdom of Swaziland, Africa

Emergency care is available in many forms in Swaziland, and to our knowledge there has never been a systematic study of emergency centres (ECs) in the country. The purpose of this study was to describe the characteristics, resources and capacity of emergency centres in the Kingdom. Methods: The National Emergency Department Inventory (NEDI)-International survey instrument (www. emnet-nedi.org) was used to survey all Swaziland ECs accessible to the general public 24/7. EC staff were asked about calendar year 2014. Data were entered directly into Lime Survey, a free, web-based, open- source survey application. Responses were analysed using descriptive statistics, including proportions and medians with interquartile ranges (IQR). Results: Sixteen of 17 ECs participated (94% response rate). Participating ECs were either in hospitals (69%) or health centres (31%). ECs had a median of 53,399 visits per year (IQR 15,000–97,895). Fourteen (88%) ECs had a contiguous layout, and the other two (12%) were non-contiguous. Overall, eight (53%) had access to cardiac monitors and 11 (69%) had a 24/7 clinical laboratory available. Only 1 (6%) EC had a dedicated CT scanner, while 2 (13%) others had limited access through their hospital. The typical EC length-of-stay was between 1 and 6 h (44%). The most commonly available specialists were general sur- geons, with 9 (56%) ECs having them available for in-person consultation. No ECs had a plastic surgeon or psychiatrist available. Overall, 75% of ECs reported running at overcapacity. Discussion: Swaziland ECs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major chal- lenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.