Emergency care knowledge, utilization, and barriers in Northern Tanzania: A community-based survey

Background: Emergency care systems are critical to improving care for time-sensitive emergency conditions. The growth and development of these systems in Sub-Saharan Africa is becoming a priority. Layperson knowledge and recognition of emergency symptoms and subsequent care-seeking behavior are key to achieving timely access to care and appropriate treatment. This study aimed to assess community knowledge of emergency conditions as well as barriers to accessing the emergency care system in Northern Tanzania. Methods: This was a cross-sectional study of households in three districts in Kilimanjaro, Tanzania from June to September 2021. The primary outcome was an inappropriate response to any of five hypothetical emergency conditions. Secondary outcomes were the incidence of household emergencies and delay in care access for those with emergency conditions. Data were analyzed using descriptive statistics. Associations between the outcome of interest and select household characteristics were analyzed using Fisher’s Exact tests for categorical measures and Wilcoxon rank-sum tests for continuous measures. Results: A total of 539 households were interviewed with 2,274 participants. The majority (46.8%) were from Moshi District Council. 73.7% used cash and/or had no insurance. The mean monthly household income was 226,107.6 Tanzanian Shillings. 76 (14.1%) households reported experiencing an emergency condition in the past year and 225 (41.7%) of respondents had an inappropriate response to at least one hypothetical emergency condition. A higher proportion of those with delayed access to healthcare paid with personal cash and a lower proportion had national health insurance. A higher proportion of those with inappropriate responses to hypothetical emergency conditions lived in rural districts, were uninsured, and had a lower mean income. Conclusion: Community-dwelling adults in Northern Tanzania have significant gaps in understanding of emergency care conditions and delayed access to care for these conditions. Distance to the healthcare facilities, cost, and lack of insurance may contribute to care delays. Increasing insurance coverage and developing emergency medical services may improve access to care.