Why people die in medical emergencies in SA

Many medical conditions, such as serious injuries, sepsis and heart attacks, need high-quality emergency care quickly – or the patient may die. These time-critical conditions cause about half of all deaths worldwide, and they are more common in countries with lower incomes.

Dangerous delays may happen at three points: the patient deciding to seek care, reaching a healthcare facility, and receiving quality care at that facility.

The World Health Assembly has called for improved care for time-critical conditions, but the necessary development and research has not always received enough funding.

One of the reasons for this may be a scarcity of information. It’s difficult to record deaths and their causes accurately in settings where civil registration systems and health records are poor. But in some countries, verbal autopsies, which are interviews with the relative or carer of the deceased, are performed to find out about the circumstances around a death and what most likely caused it.

During a verbal autopsy, information is asked about where and when the patient sought care.

A study was carried out in the Agincourt area of Mpumalanga to find out more about deaths from time-critical conditions.

The aim was to find out what prevented people from seeking, reaching and receiving quality care in this area, where access to multiple healthcare facilities via paved roads is possible.

The study reviewed 15 305 verbal autopsies. A locally appropriate definition of time-critical conditions was developed and the study looked at the numbers of deaths due to these, how numbers changed over time, and how the numbers differed by age and sex.

The study also looked at delays in accessing care for these conditions and where people went (if they did try to get care).

It was found that time-critical conditions were responsible for substantial deaths in this rural population. Delays in seeking and receiving quality care were more prominent than delays in reaching care.

The definition of time-critical conditions used was “those requiring prompt medical care within 12 hours from the onset of symptoms recognised by a layperson to prevent death”.

Some of the most common conditions seen were obstetric haemorrhage (bleeding too much in pregnancy or around the time of birth), pneumonia and assault.

It was found that between 1993 and 2015, 38.45% of all deaths in the study population were due to time-critical conditions. The proportion increased and accounted for nearly 50% of all deaths in 2014.

Most who died were very young or over 60 years old. About three-quarters of deaths in the first 28 days of life were due to time-critical conditions. About half of all time-critical deaths were due to non-infectious conditions.

Delays in accessing care were seen at the stage of making the decision to seek care.

Looking at patterns of seeking care before death, most commonly patients did not seek any care and died without going to a healthcare facility.

The most prominent single issue identified in causing delays was cost. This is despite public healthcare in the area being free. People may not know this, or they may worry about the cost of transport to a facility or loss of income while in hospital. They may also not seek care because they do not trust the facility’s ability to treat them.

The study also found that for people who did reach a healthcare facility, quality issues were prominent. Relatives reported that patients had problems in timely referral, waiting to be seen, and communication.

Justine Ina Davies is professor of Global Health, Institute for Applied Research, University of Birmingham

Contributor: Andrew Fraser is a consultant at Guy’s and St Thomas’ NHS Foundation Trust Republished from The

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