The populations of most resource-poor countries live in remote rural areas far from hospitals where presentations are to health centres with limited facilities without doctors and often without health officers; however, the majority of research in such countries has focused on validating triage tools within hospital settings. Simple effective triage is particularly important where primary healthcare is limited or non-functional but validated triage tools have not included health promotion or extended programme immunisation (EPI) screening. Implementation of a multi-faceted triage system incorporating both EPI screening and health promotion was assessed in Southern Ethiopia.
Over two months all children under 5 presenting to a Médecins Sans Frontiéres supported health centre in Chire in the rural highlands of Southern Ethiopia were triaged using the South African Triage Scale (SATS) by nurse supervisor. Prior training was given on recognising the sick child, SATS triage, EPI schedule and focused health education. Patients were triaged and either treated directly by triage nurse or sent to OPD for health officer/OPD nurse consultation. In addition, all children including siblings were screened for vaccine eligibility as per EPI schedule and offered this. Common illness health promotion (diarrhoea and dehydration management, malnutrition, pneumonia, and vaccinations) ran alongside with health educator. Data was recorded for total number presenting to health centre, number OPD consultations, mortality and hospital referral rates, and number receiving EPI.
From May to June 2013, there was reduction in total number presentations from 1342 to 1170 (87%). Of those presenting, 723 (62%) were referred for OPD consultation. Top morbidities were respiratory infection 29%, skin diseases 22%, and diarrhoeal diseases 12%. Mortality rose from 1 case (0.07%) to 3 (0.26%) although more critical cases presented within rainy season. Hospital referrals reduced from 2 cases (0.15%) to 1 (0.09%). EPI uptake improved with oral Polio (124%) and Penta (170%).
The results of this intervention demonstrate that SATS triage system can be used safely and effectively in rural settings reducing high consultation numbers. Integrating immunisation screening significantly increased EPI uptake. Longer follow up would allow for more careful analysis of the effect of health promotion on disease presentation and mortality.