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| SHORT REPORT |
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| Year : 2023 | Volume
: 22
| Issue : 3 | Page : 399-401 |
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The paucity of pediatric emergency medicine fellowship training programs in Africa
Patrick Ovie Fueta
Department of Pediatrics, Driscoll Children's Hospital, Texas, USA
| Date of Submission | 02-Aug-2022 |
| Date of Decision | 01-Apr-2023 |
| Date of Acceptance | 02-May-2023 |
| Date of Web Publication | 4-Jul-2023 |
Correspondence Address:
Patrick Ovie Fueta
Department of Pediatrics, Driscoll Children's Hospital, 3533 S. Alameda St., Corpus Christi 78411, Texas
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aam.aam_115_22
 Abstract | | |
Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.
Résumé
L'Afrique subsaharienne a le plus grand fardeau de la mortalité infantile et des adolescents dans le monde. Les principales causes de mortalité dans les populations pédiatriques en Afrique comprennent les complications prématurées, la pneumonie, le paludisme, les maladies diarrhéiques, le VIH / sida et les lésions routières. Ces causes de mortalité infantile et des adolescents conduisent souvent à l'utilisation des salles d'urgence en raison de la présentation critique, mettant l'accent sur l'importance des services d'urgence pédiatriques en Afrique. Malgré la criticité de la médecine d'urgence pédiatrique (PEM) dans la région, il y a un manque de programmes de formation PEM en Afrique. Les interventions en cours axées sur la lutte contre le mauvais accès à la formation et aux services PEM comprennent des efforts isolés pour fournir des formation spécifiques au PEM aux praticiens de médecine non urgente (EM) et étendre la formation actuelle EM pour inclure le PEM piloté dans un seul centre au Kenya. Les efforts durables nécessitent des efforts organisés avec le gouvernement et les organismes de formation médicale diplômés. Nous discutons de l'infrastructure existante qui peut être utilisée dans la promotion de la création de programmes de formation PEM et exhorte les investissements des gouvernements locaux ainsi que d'autres parties prenantes, y compris l'enseignement médical diplômé, pour résoudre la question de la mortalité infantile en Afrique grâce à l'amélioration de la fourniture et de l'accès à Formation PEM
Mots-clés: Bourse, santé mondiale, éducation médicale diplômée, médecine d'urgence pédiatrique
Keywords: Fellowship, global health, graduate medical education, pediatric emergency medicine
How to cite this article:
Fueta PO. The paucity of pediatric emergency medicine fellowship training programs in Africa. Ann Afr Med 2023;22:399-401 |
| Importance and Need for Pediatric Emergency Care in Africa | |  |
Sub-Saharan Africa has the world's highest burden of childhood and adolescent mortality.[1] African nations have the highest birth rates and population of children globally, with Niger having the highest birth rate of 47.08/1000 compared to the United States, with a rate of 1.84/1000.[2] Putting these statistics into perspective, the undue burden of mortality in Africa, a region with the highest global birth rates, places emphasis on the importance of identifying and mitigating the underlying causes of mortality in this vulnerable population.[2]
The causes of mortality in pediatric populations in Africa vary by age.[1] The leading causes of mortality in pediatric populations include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries.[1] These causes of childhood and adolescent mortality often lead to emergency room utilization due to acute presentation in states of critical illness, and this underscores the importance of providing excellent pediatric emergency care in the region.
| Current State of Pediatric Emergency Medicine in Africa | | |
Despite the criticality of the specialty of pediatric emergency medicine (PEM) to pediatric populations, pediatric emergency care in Africa is largely provided by physicians without any formal PEM training.[3] PEM fellowship training has been established in several developed nations to provide excellent emergency care to this unique population.[3] The West African College of Physicians (WACP) and the East, central, and South Africa College of Physicians do not currently offer PEM training, which emphasizes the absence of PEM training in Africa.[4],[5] At present, pediatric emergency and critical care, Kenya, is the only formal pediatric emergency and critical care fellowship program in Africa.[6] While this effort is applaudable, it does not address the paucity of PEM training on the continent. The crucial need for robust training in PEM cannot be overemphasized and prompts our urgent call for the widespread development of specialized PEM fellowship training programs across Africa.
The establishment of global tracks within select US PEM fellowship programs represents global efforts to address the paucity of PEM training in Africa through exchange programs. Some of such programs include the Baylor/Texas children's PEM – global health fellowship program with fellows in Botswana and Malawi and children's Hospital of Philadelphia PEM – global health fellowship program with fellows in Malawi, to mention a few.[7],[8] Other efforts to provide training in pediatric emergency care in Africa include the expansion of emergency medicine (EM) training programs to include pediatric-specific training and an implemented district-level pediatric emergency curriculum for nonfellowship-trained pediatric emergency care providers in Kenya.[9] Although these efforts are commendable, they are not evenly distributed across the continent, with most programs established in the east and south of Africa, and they do not provide the same expertise PEM fellowship training provides in the 2–3 years of rigorous fellowship training. More so, very few African countries have established EM programs, hence lacking the capability of expanding EM training to cater to pediatric populations.[9] The core solution(s) should focus on establishing PEM fellowships as subspecialty training programs provided by graduate medical education bodies such as the WACP to ensure its sustainability.
| Current Systems to Provide Pediatric Emergency Care in Other Developing Countries | | |
The scarcity of PEM training in Africa is evident, poorly discussed, and it requires sustained efforts to address the ongoing need to provide excellent pediatric emergency care in the region. Proposed solutions should tailor to the limited resources in the region and utilizing existing infrastructure is critical to success. The success of Latin America, a resource-limited setting, in establishing 11 PEM training programs across six countries as 1–2-year-long training programs providing training to EM and pediatric-trained physicians in response to the overwhelming need to provide high-quality pediatric emergency care in the region provides the framework to replicate this success in Africa.[10]
Mota Curiel et al., in their article, highlighted the major factors in favor of the establishment of PEM training programs in Latin America, with the top reason being the interest of local pediatricians in acquiring advanced skills in pediatric emergency care.[10] Other factors included critically ill patients in the emergency room, international requirements, and EM physicians interested in specialized PEM training. Among countries where PEM programs were established, they were approved by the local universities and the ministries of health.[10] The authors highlight challenges faced in the establishment of PEM programs, including a lack of physicians adequately trained in PEM to serve as program directors, training in critical aspects of PEM, lack of training infrastructure/sites for future fellows, and acknowledgment from local health authorities on the importance of establishing PEM training programs.[10] This emphasizes the importance of recognition from governments and professional bodies such as the local ministry of health, which was critical in the establishment and sustainment of PEM training programs in Latin America.[10]
| Initiative to Develop Pediatric Emergency Medicine Training in Africa | | |
EM as a specialty was established in Africa in 2004, with South Africa being the pioneer nation. At present, 15 EM residency programs have been established in 12 countries across the continent, including Egypt, Sudan, Libya, Kenya, Ethiopia, Malawi, Mozambique, Tanzania, Rwanda, and Ghana.[11] The establishment of EM training in Africa demonstrates local interest in EM, and the existing EM training programs provide promising infrastructure for the establishment of specialized PEM fellowship training programs in Africa. The African Federation of EM (AFEM) is an established medical education body that oversees EM training in Africa, and the topic of establishing PEM training ties in with the vision statement of AFEM “we envision an Africa where high-quality emergency care is realized for all.”[11] Drawing from the experience of Latin America in the establishment of PEM training programs, engaging AFEM is critical in ensuring the establishment and sustainment of PEM training programs in Africa and it provides the groundwork to utilize the existing EM training infrastructure.[10] Furthermore, US PEM fellowship programs with global health tracks stationed in Africa provide utilizable infrastructure for the development of PEM training programs in Africa. These programs are well experienced in curriculum development, and they potentially can play an important role in the development of sustainable curriculums for PEM training in Africa. Importantly, establishing high-quality PEM training programs in Africa is mutually beneficial as visiting fellows will benefit from PEM training facilities well suited for providing EM services in the tropics. Through this collaborative effort, local physicians trained in PEM can be retained to serve as program directors, thereby ensuring the longevity of PEM training programs and the specialty in Africa. Success at this level could potentially attract interest and investment from larger medical education bodies such as WACP and ESCACOP in PEM and accelerate the establishment of PEM training programs in Africa.
The current regional and global efforts focused on addressing child and adolescent morbidity and mortality in Africa are incomplete without addressing the paucity of PEM training on the continent. Establishing PEM fellowship training programs in Africa is crucial in providing sustainable, high-quality pediatric emergency care in the region.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Strong KL, Pedersen J, White Johansson E, Cao B, Diaz T, Guthold R, et al. Patterns and trends in causes of child and adolescent mortality 2000-2016: Setting the scene for child health redesign. BMJ Glob Health 2021;6:e004760.  |
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| 3. | Fant CD, Schwartz KR, Patel H, Fredricks K, Nelson BD, Ouma K, et al. Developing and implementing a pediatric emergency care curriculum for providers at district level hospitals in Sub-Saharan Africa: A case study in Kenya. Front Public Health 2017;5:322. |
| 4. | The College – West African College of Physicians. West African College of Physicians – Association of Medical Specialists. Available from: https://wacpcoam.org/. [Last retrieved on 2022 May 29]. |
| 5. | East, Central and Southern Africa College of Physicians. ECSACOP. Available from: https://ecsacop.org/. [Last retrieved on 2022 May 29]. |
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| 9. | Sawe HR, Akomeah A, Mfinanga JA, Runyon MS, Noste E. Emergency medicine residency training in Africa: Overview of curriculum. BMC Med Educ 2019;19:294. |
| 10. | Mota Curiel C, Yock-Corrales A, Contreras C, Corona L, Pavlichiv V, Álvarez E, et al. Pediatric emergency medicine training: A survey of current status in Latin America. Pediatr Emerg Care 2022;38:e766-70. |
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