The Paucity of Pediatric Emergency Medicine Fellowship Training Programs in Africa
MPORTANCE AND N EED FOR P EDIATRIC E MERGENCY C ARE IN A FRICA Sub-Saharan Africa has the world's highest burden of childhood and adolescent mortality. African nations have the highest birth rates and population of children globally, with Niger having the highest birth rate of 47.08/1000 compared to the United States, with a rate of 1.84/1000. Putting these statistics into perspective, the undue burden of mortality in Africa, a region with the highest global birth rates, places emphasis on the importance of identifying and mitigating the underlying causes of mortality in this vulnerable population. The causes of mortality in pediatric populations in Africa vary by age. The leading causes of mortality in pediatric populations include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to acute presentation in states of critical illness, and this underscores the importance of providing excellent pediatric emergency care in the region.   URRENT S TATE OF P EDIATRIC E MERGENCY M EDICINE IN A FRICA Despite the criticality of the specialty of pediatric emergency medicine (PEM) to pediatric populations, pediatric emergency care in Africa is largely provided by physicians without any formal PEM training. PEM fellowship training has been established in several developed nations to provide excellent emergency care to this unique population. The West African College of Physicians (WACP) and the East, central, and South Africa College of Physicians do not currently offer PEM training, which emphasizes the absence of PEM training in Africa. At present, pediatric emergency and critical care, Kenya, is the only formal pediatric emergency and critical care fellowship program in Africa. While this effort is applaudable, it does not address the paucity of PEM training on the continent. The crucial need for robust training in PEM cannot be overemphasized and prompts our urgent call for the widespread development of specialized PEM fellowship training programs across Africa. The establishment of global tracks within select US PEM fellowship programs represents global efforts to address the paucity of PEM training in Africa through exchange programs. Some of such programs include the Baylor/Texas children's PEM – global health fellowship program with fellows in Botswana and Malawi and children's Hospital of Philadelphia PEM – global health fellowship program with fellows in Malawi, to mention a few. Other efforts to provide training in pediatric emergency care in Africa include the expansion of emergency medicine (EM) training programs to include pediatric-specific training and an implemented district-level pediatric emergency curriculum for nonfellowship-trained pediatric emergency care providers in Kenya. Although these efforts are commendable, they are not evenly distributed across the continent, with most programs established in the east and south of Africa, and they do not provide the same expertise PEM fellowship training provides in the 2–3 years of rigorous fellowship training. More so, very few African countries have established EM programs, hence lacking the capability of expanding EM training to cater to pediatric populations. The core solution(s) should focus on establishing PEM fellowships as subspecialty training programs provided by graduate medical education bodies such as the WACP to ensure its sustainability.   URRENT S YSTEMS TO P ROVIDE P EDIATRIC E MERGENCY C ARE IN O THER D EVELOPING C OUNTRIES The scarcity of PEM training in Africa is evident, poorly discussed, and it requires sustained efforts to address the ongoing need to provide excellent pediatric emergency care in the region. Proposed solutions should tailor to the limited resources in the region and utilizing existing infrastructure is critical to success. The success of Latin America, a resource-limited setting, in establishing 11 PEM training programs across six countries as 1–2-year-long training programs providing training to EM and pediatric-trained physicians in response to the overwhelming need to provide high-quality pediatric emergency care in the region provides the framework to replicate this success in Africa. Mota Curiel et al ., in their article, highlighted the major factors in favor of the establishment of PEM training programs in Latin America, with the top reason being the interest of local pediatricians in acquiring advanced skills in pediatric emergency care. Other factors included critically ill patients in the emergency room, international requirements, and EM physicians interested in specialized PEM training. Among countries where PEM programs were established, they were approved by the local universities and the ministries of health. The authors highlight challenges faced in the establishment of PEM programs, including a lack of physicians adequately trained in PEM to serve as program directors, training in critical aspects of PEM, lack of training infrastructure/sites for future fellows, and acknowledgment from local health authorities on the importance of establishing PEM training programs. This emphasizes the importance of recognition from governments and professional bodies such as the local ministry of health, which was critical in the establishment and sustainment of PEM training programs in Latin America.   NITIATIVE TO D EVELOP P EDIATRIC E MERGENCY M EDICINE T RAINING IN A FRICA EM as a specialty was established in Africa in 2004, with South Africa being the pioneer nation. At present, 15 EM residency programs have been established in 12 countries across the continent, including Egypt, Sudan, Libya, Kenya, Ethiopia, Malawi, Mozambique, Tanzania, Rwanda, and Ghana. The establishment of EM training in Africa demonstrates local interest in EM, and the existing EM training programs provide promising infrastructure for the establishment of specialized PEM fellowship training programs in Africa. The African Federation of EM (AFEM) is an established medical education body that oversees EM training in Africa, and the topic of establishing PEM training ties in with the vision statement of AFEM “we envision an Africa where high-quality emergency care is realized for all.” Drawing from the experience of Latin America in the establishment of PEM training programs, engaging AFEM is critical in ensuring the establishment and sustainment of PEM training programs in Africa and it provides the groundwork to utilize the existing EM training infrastructure. Furthermore, US PEM fellowship programs with global health tracks stationed in Africa provide utilizable infrastructure for the development of PEM training programs in Africa. These programs are well experienced in curriculum development, and they potentially can play an important role in the development of sustainable curriculums for PEM training in Africa. Importantly, establishing high-quality PEM training programs in Africa is mutually beneficial as visiting fellows will benefit from PEM training facilities well suited for providing EM services in the tropics. Through this collaborative effort, local physicians trained in PEM can be retained to serve as program directors, thereby ensuring the longevity of PEM training programs and the specialty in Africa. Success at this level could potentially attract interest and investment from larger medical education bodies such as WACP and ESCACOP in PEM and accelerate the establishment of PEM training programs in Africa. The current regional and global efforts focused on addressing child and adolescent morbidity and mortality in Africa are incomplete without addressing the paucity of PEM training on the continent. Establishing PEM fellowship training programs in Africa is crucial in providing sustainable, high-quality pediatric emergency care in the region. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.   Nil.   There are no conflicts of interest.   