South Africa

Timeline: July 2012 – Ongoing

The impact of prioritizing critically ill children in resource limited primary healthcare centers, on the burden of morbidity and mortality in children under the age of five years in Cape Town, SA

Background Information:

Interventions to improve triage have been shown to reduce childhood mortality in resource-constrained settings. In South Africa, 10% of children die before age five.  Ninety percent of health care is delivered in nurse-led primary care clinics (PHCs) that have no provisions for emergency care delivery. The WHO estimates that 10-20% of children presenting to PHCs are already critically ill and would benefit from onward referral. Identifying this need the investigator developed a screening tool to evaluate critically unwell children in PHCs.  There are no studies to evaluate the impact of triage implementation on patient outcomes in low and middle-income countries (LMICs). The few validation studies for low resource settings that do exist use surrogate outcomes such as disposition and time metrics. In Cape Town all critically ill children are referred to a single tertiary care facility, thus this study may feasibly measure the impact of triage on longitudinal patient outcomes. Only one triage tool (IMCI) has been validated in PHCs, where critically unwell children present and are often missed. This study seeks to quantify the impact of screening for critically ill children in PHCs on clinical outcomes.


The  aims of the research project are to: 1) adapt the existing WHO Emergency Triage and Assessment Tool (ETAT) to resource constrained PHCs in Cape Town, SA; 2) evaluate the performance of the modified triage tool in PHCs; 3) evaluate the impact of the tool on patient care in PHCs using process mapping; and 4) evaluate the impact of the tool on longitudinal clinical outcomes in critically ill children. We hypothesize that: 1) the modified ETAT can improve usability in PHCs; 2) the modified ETAT will be highly sensitive in identifying critically ill children; 3) the triage tool can improve the time to treatment and transfer of critically-ill children; and 4) the modified ETAT can improve clinical outcomes.


Dr. Hansoti was recently awarded a Fogarty Fellowship Award which will provide all necessary funds for equipment and the conduct of this research. If the study is successful and found to positively impact clinical outcomes in critically unwell children, eventually all 109 sites will receive the training and staff to use the tool. This portion of the project will be funded by the City of Cape Town.