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Clinical emergency care research in low-income and middle-income countries: opportunities and challenges
  1. Adam R Aluisio1,
  2. Shahan Waheed2,
  3. Peter Cameron3,
  4. Jermey Hess4,
  5. Shevin T Jacob5,
  6. Niranjan Kissoon6,
  7. Adam C Levine1,
  8. Asad Mian2,
  9. Shammi Ramlakhan7,8,
  10. Hendry R Sawe9,
  11. Junaid Razzak10
  1. 1Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
  2. 2Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
  3. 3Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  4. 4Department of Emergency Medicine, School of Public Health, University of Washington, Seattle, Washington, USA
  5. 5Division of Allergy and Infectious Diseases, Universityof Washington, Seattlel, WA, United States
  6. 6Departmentof Pediatrics and Emergency Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Emergency Department, Sheffield Children's Hospital, Sheffield, UK
  8. 8Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
  9. 9Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  10. 10Department of Emergency Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Adam R Aluisio; adam.aluisio{at}gmail.com

Abstract

Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved. However, in LMICs, clinical research, especially interventional trials, in emergency care are rare. Furthermore, there exists minimal research on the emergency management of diseases, which are rarely encountered in HICs but impact the majority of LMIC populations. This paper explores challenges in conducting clinical research in patients with emergency conditions in LMICs, identifies examples of successful clinical research and highlights the system, individual and study design characteristics that made such research possible in LMICs. Derived from the available literature, a focused list of high impact research considerations are put forth.

  • public health
  • study design
  • diseases
  • disorders
  • injuries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjgh-2018-001289

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors All authors took part in drafting and revising the manuscript and approve of the submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no original data associated with this manuscript.