A retrospective analysis of emergency department usage in rural and semi-urban indigenous Guatemalan populations


Submitted: 27 October 2021
Accepted: 13 January 2022
Published: 8 February 2022
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Authors

  • Emma Svenson University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States.
  • Amber Sheth University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States.
  • Jessica Schmidt Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States.
  • Rafael Tun Hospital Parroquial de San Lucas Tolimán, San Lucas Tolimán, Guatemala.
  • James E. Svenson Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States.

Functioning healthcare systems provide emergency medical care. Disparities exist in accessibility and availability of emergency care in low- and middle-income countries. We present a descriptive epidemiologic analysis of Emergency Department (ED) usage in a rural, indigenous Guatemalan population. San Lucas Tolimán is situated in central Guatemala. Hospital Parroquial de San Lucas offers emergency care to San Lucas Tolimán and surrounding villages. All ED visits between January 1st, 2016 and December 31st 2018 were recorded and analyzed. During the study period, 12,229 patient encounters occurred. Almost all patients identified as indigenous. Children comprised 43% of visits. Medical issues represented a majority (83%) of complaints. Respiratory (40%) and gastrointestinal disease (26%) were frequent presenting complaints. Almost all visits (83%) occurred during the day and evening hours. Trauma/surgical complaints were slightly more frequent at night. 93% of patients were discharged, while the rest were admitted or transferred. These data contribute to understanding of disease burden and emergency care needs and capacity in rural areas of low- and middle-income countries. This information may be used to inform local policy decisions, identify research priorities, and create training topics for local health care providers in Guatemala and other countries in this region.


Coyle RM, Harrison HL. Emergency care capacity in Freetown, Sierra Leone: a service evaluation. BMC Emerg Med 2015;15:2.

Burke TF, Hines R, Ahn R, et al. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya. BMJ Open 2014;4:e006132.

Hsia R, Razzak J, Tsai AC, Hirshon JM. Placing emergency care on the global agenda. Ann Emerg Med 2010;56:142-9.

Shanahan T, Risko N, Razzak J, Bhutta Z. Aligning emergency care with global health priorities. Int J Emerg Med 2018;11:52.

Fortuna RJ, Robbins BW, Mani N, Halterman JS. Dependence on emergency care among young adults in the United States. J Gen Intern Med 2010;25:663-9.

Howard MS, Davis BA, Anderson C, et al. Patients’ perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs 2005;31:429-35.

Kobusingye OC, Hyder AA, Bishai D, et al. Emergency medical services. In: Jamison DT, Breman JG, Measham AR, et al., eds. Disease control priorities in developing countries. 2nd ed. World Bank; 2006.

Smith J, Haile-Mariam T. Priorities in global emergency medicine development. Emerg Med Clin North Am 2005;23:11-29.

Obermeyer Z, Abujaber S, Makar M, et al. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ 2015;93:577-586G.

Razzak JA, Hyder AA, Akhtar T, et al. Assessing emergency medical care in low income countries: a pilot study from Pakistan. BMC Emerg Med 2008;8:8.

Johnson T, Gaus D, Herrera D. Emergency Department of a Rural Hospital in Ecuador. West J Emerg Med 2016;17:66-72.

Hess A, Thomas T, Contreras R, Green GB. Development of emergency medical services in Guatemala. Prehospital Emerg Care 2004;8:308-12.

Baker T, Lugazia E, Eriksen J, et al. Emergency and critical care services in Tanzania: a survey of ten hospitals. BMC Health Serv Res 2013;13:140.

Reynolds TA, Mfinanga JA, Sawe HR, et al. Emergency care capacity in Africa: A clinical and educational initiative in Tanzania. J Public Health Pol 2012;33:S126-37.

Duke T, Cheema B. Paediatric emergency and acute care in resource poor settings. J Paediatr Child Health 2016;52:221-6.

Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Organ 2009;87:246.

Levine AC, Presser DZ, Rosborough S, et al. Understanding barriers to emergency care in low-income countries: view from the front line. Prehosp Disaster Med 2007;22:467-70.

Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLOS Med 2008;5:e175.

Kouo-Ngamby M, Dissak-Delon FN, Feldhaus I, Juillard C, Stevens KA, Ekeke-Monono M. A cross-sectional survey of emergency and essential surgical care capacity among hospitals with high trauma burden in a Central African country. BMC Health Serv Res 2015;15:478.

Japiong KB, Asiamah G, Owusu-Dabo E, et al. Availability of resources for emergency care at a second-level hospital in Ghana: A mixed methods assessment. Afr J Emerg Med 2016;6:30-7.

Anthony DR. Promoting emergency medical care systems in the developing world: weighing the costs. Glob Public Health 2011;6:906-13.

Mowafi H, Ngaruiya C, O’Reilly G, et al. Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research. BMJ Glob Health 2019;4:e001442.

Holliman CJ, VanRooyen MJ, Green GB, et al. Planning Recommendations for International Emergency Medicine and Out-of-hospital Care System Development. Acad Emerg Med 2000;7:911-7.

Alagappan K, Schafermeyer R, Holliman CJ, et al. International emergency medicine and the role for academic emergency medicine. Acad Emerg Med 2007;14:451-6.

Reynolds TA, Bisanzo M, Dworkis D, et al. Research priorities for data collection and management within global acute and emergency care systems. Acad Emerg Med 2013;20:1246-50.

Paniagua-Avila MA, Messenger E, Nelson CA, et al. The Guatemala-Penn Partners: an innovative inter-institutional model for scientific capacity-building, healthcare education, and public health. Front Public Health 2017;5:70.

Universidad de San Carlos de Guatemala, Guatemala City, Guatemala. RoshReview.com. Accessed December 5, 2020. Available from: https://www.roshreview.com/global-foundation/profile/universidad-de-san-carlos-de-guatemala-guatemala-city-guatemala/

Chary A, Flood D, Austad K, et al. Accompanying indigenous Maya patients with complex medical needs: A patient navigation system in rural Guatemala. Healthc (Amst) 2018;6:144-9.

Browne AJ, Smye VL, Rodney P, et al. Access to primary care from the perspective of aboriginal patients at an urban emergency department. Qual Health Res 2011;21:333-48.

Thomas DP, Anderson IP. Use of emergency departments by Aboriginal and Torres Strait Islander people. Emerg Med Australasia 2006;18:68-76.

Arnaert A, Schaack G. Cultural awareness of Inuit patients’ experiences with emergency nursing care. Accident Emerg Nursing 2006;14:97-103.

Dell EM, Firestone M, Smylie J, Vaillancourt S. Cultural safety and providing care to aboriginal patients in the emergency department. Can J Emerg Med 2016;18:301-5.

Berg K, McLane P, Eshkakogan N, et al. Perspectives on Indigenous cultural competency and safety in Canadian hospital emergency departments: A scoping review. Int Emerg Nursing 2019;43:133-40.

Johnston‐Leek M, Sprivulis P, Stella J, Palmer D. Emergency department triage of indigenous and non-indigenous patients in tropical Australia. Emerg Med 2001;13:333-7.

Green T, Green H, Scandlyn J, Kestler A. Perceptions of short-term medical volunteer work: a qualitative study in Guatemala. Global Health 2009;5:4.

Berry NS. Who’s Judging the Quality of Care? Indigenous Maya and the Problem of “Not Being Attended.” Med Anthropol 2008;27:164-89.

Cerón A, Ruano AL, Sánchez S, et al. Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala. Int J Equity Health 2016;15:77.

Ruano AL, Sánchez S, Jerez FJ, Flores W. Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala. Int J Equity Health 2014;13:57.

Lindblade KA, Johnson AJ, Arvelo W, et al. Low usage of government healthcare facilities for acute respiratory infections in guatemala: implications for influenza surveillance. BMC Public Health 2011;11:885.

Van Der Stuyft P, Delgado E, Sorensen SC. Utilisation rates and expenditure for public and private, curative-care services in semi-urban Guatemala. Ann Tropical Med Parasitol 1997;91:209-16.

Berry NS. Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home. Soc Sci Med 2006;62:1958-69.

Becker S, Fonseca-Becker F, Schenck-Yglesias C. Husbands’ and wives’ reports of women’s decision-making power in Western Guatemala and their effects on preventive health behaviors. Soc Sci Med 2006;62:2313-26.

Rööst M, Johnsdotter S, Liljestrand J, Essén B. A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala. BJOG 2004;111:1372-7.

Delaney PG, Figueroa JA, Eisner ZJ, et al. Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala. Trauma Surg Acute Care Open 2020;5:e000409.

Walker DM, Holme F, Zelek ST, et al. A process evaluation of PRONTO simulation training for obstetric and neonatal emergency response teams in Guatemala. BMC Med Educ 2015;15:117.

Crouse HL, Torres F, Vaides H, et al. Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital. Paed Int Child Health 2016;36:219-24.

Bose S, Bream K, Barg F, Band R. Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study. Acad Emerg Med 2012;19:793-800.

Evanson TA, Zust BL. The meaning of participation in an international service experience among baccalaureate nursing students. Int J Nurs Educ Scholarship 2004;1:1070

Andrews CM, Wyne K, Svenson JE. The use of traditional and complementary medicine for diabetes in rural Guatemala. J Health Care Poor Underserved 2018;29:1188-208.

Chickering WH. A guide for visiting clinicians to Guatemala: common presenting symptoms and treatment. J Transcult Nurs 2006;17:190-7.

Chamarbagwala R, Morán HE. The human capital consequences of civil war: Evidence from Guatemala. J Devel Econ 2011;94:41-61.

Svenson EL, Tun R, Conway JH, et al. A one health approach to compare self-prescribed antibiotic use across rural and semi-urban populations in San Lucas Tolimán, Guatemala. J Health Care Poor Underserved 2021;32:1798-817.

Sperling J. The influence of poverty and violence on the therapeutic landscapes of the Kaqchikel. Published online 2006. Accessed December 26, 2021. Available from: https://uwspace.uwaterloo.ca/handle/10012/982

Ao T, McCracken JP, Lopez MR, et al. Hospitalization and death among patients with influenza, Guatemala, 2008–2012. BMC Public Health 2019;19:463.

Gragnolati M, Marini A. Health and poverty in Guatemala. Soc Sci Res Network 2003. Accessed December 22, 2021. Available from: https://papers.ssrn.com/abstract=636328

Bowser DM, Mahal A. Guatemala: The economic burden of illness and health system implications. Health Policy 2011;100:159-66.

Becerril-Montekio V. Sistema de salud de Guatemala. Salud Pública de México 2011;53:12.

Peltan ID. Disaster relief and recovery after a landslide at a small, rural hospital in Guatemala. Prehosp Disaster Med 2009;24:542-8.

Duffy S, Norton D, Kelly M, et al. Using community health workers and a smartphone application to improve diabetes control in rural Guatemala. Glob Health Sci Pract 2020;8:699-720.

Inicio. HOSPITAL GREGORIO SCHAFFER. Accessed December 22, 2021. http://hospitalgregorioschaffer.org/

Healthcare – Friends of San Lucas. Accessed December 26, 2021. https://sanlucasmission.org/programs/healthcare/

López-Carr D, Davis J, Jankowska MM, et al. Space versus place in complex human–natural systems: Spatial and multi-level models of tropical land use and cover change (LUCC) in Guatemala. Ecological Modelling 2012;229:64-75.

Chang CY, Abujaber S, Reynolds TA, et al. Burden of emergency conditions and emergency care utilization: New estimates from 40 countries. Emerg Med J 2016;33:794-800.

Mowafi H, Dworkis D, Bisanzo M, et al. Making recording and analysis of chief complaint a priority for global emergency care research in low-income countries. Acad Emerg Med 2013;20:1241-5.

Kironji AG, Hodkinson P, de Ramirez SS, et al. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC Health Serv Res 2018;18:291.

Tiwari Y, Goel S, Singh A. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India. J Emerg Trauma Shock 2014;7:160-5.

Wesson HKH, Stevens KA, Bachani AM, et al. Trauma systems in Kenya: A qualitative analysis at the district level. Qualitative Health Research 2015;25:589-99.

Chomat AM, Kring B, Bekker LP. Approaching maternal health from a decolonized, systemic, and culturally safe approach: case study of the Mayan-indigenous populations of Guatemala. In: Schwartz DA, ed. Maternal death and pregnancy-related morbidity among indigenous women of Mexico and Central America: An anthropological, epidemiological, and biomedical approach. Global Maternal and Child Health. Springer International Publishing; 2018:483-511.

Lindstrom DP, Muñoz-Franco E. Migration and maternal health services utilization in rural Guatemala. Soc Sci Med 2006;63:706-21.

Razzak J, Usmani MF, Bhutta ZA. Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 Global Burden of Disease Study. BMJ Global Health 2019;4:e000733.

Salomon JA, Wang H, Freeman MK, et al. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet 2012;380:2144-62.

Viner RM, Coffey C, Mathers C, et al. 50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries. Lancet 2011;377:1162-74.

Baker T. Pediatric emergency and critical care in low-income countries. Pediatric Anesthesia 2009;19:23-7.

Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ. 2006;84:314-9.

Brugnolaro V, Fovino LN, Calgaro S, et al. Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique. PLOS One 2020;15:e0241209.

Kapoor R, Sandoval MA, Avendaño L, et al. Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala. Emerg Med J 2016;33:611-7.

Shah SJ, Barish PN, Prasad PA, et al. Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: A retrospective cohort study of patients with and without COVID-19. EClinicalMedicine 2020;27:100518.

Ikeda JM, López Tellez CA, Hudes ES, et al. Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala. AIDS Behav 2014;18:96-103.

Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Global Health 2020;8:e1132-41.

Lloyd-Sherlock P, Ebrahim S, Geffen L, McKee M. Bearing the brunt of covid-19: older people in low and middle income countries. BMJ 2020;368:m1052.

Visca D, Ong CWM, Tiberi S, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology 2021;27:151-65.

Yasri S, Wiwanitkit V. Tuberculosis and novel Wuhan coronavirus infection: Pathological interrelationship. Indian J Tuberc 2020;67:264.

Migliori GB, Thong PM, Akkerman O, et al. Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020. Emerging Infect Dis 2020;26:203163

Nachega JB, Kapata N, Sam-Agudu NA, et al. Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa. Int J Infect Dis 2021;113:S16-S21.

Martinez-Folgar K, Alburez-Gutierrez D, Paniagua-Avila A, et al. Excess mortality during the COVID-19 pandemic in Guatemala. Am J Public Health 2021;111:1839-46.

Mehmood A, Razzak JA, Kabir S, et al. Development and pilot implementation of a locally developed Trauma Registry: lessons learnt in a low-income country. BMC Emerg Med 2013;13:4.

Casey ER, Muro F, Thielman NM, et al. Analysis of traumatic injuries presenting to a referral hospital emergency department in Moshi, Tanzania. Int J Emerg Med 2012;5:28.

Ladha KS, Young JH, Ng DK, et al. Factors Affecting the Likelihood of Presentation to the Emergency Department of Trauma Patients After Discharge. Ann Emerg Med 2011;58:431-437.

Gaw CE, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med 2016;16:5.

Clark K, Rao A, Chen V, et al. We need to target trauma: A prospective observational study in Eastern Cape Province, South Africa. SAMJ 2020;110:38-43.

Blom L, Klingberg A, Laflamme L, et al. Gender differences in burns: A study from emergency centres in the Western Cape, South Africa. Burns 2016;42:1600-8.

Hode L, Madougou S, Fatigba HO, et al. The direct cost of treatment of traumatic brain injury in a Sub-Saharan African country (Benin). World Neurosurg 2017;99:210-3.

Sanyang E, Peek-Asa C, Bass P, et al. Injury factors associated with discharge status from emergency room at two major trauma hospitals in The Gambia, Africa. Injury 2017;48:1451-8.

Maegele M, Lefering R, Sakowitz O, et al. The Incidence and Management of Moderate to Severe Head Injury. Dtsch Arztebl Int 2019;116:167-73.

Arslan ED, Solakoglu AG, Komut E, et al. Assessment of maxillofacial trauma in emergency department. World J Emerg Surg 2014;9:13.

Tennakoon L, Hakes NA, Knowlton LM, Spain DA. Traumatic Injuries Due to Interpersonal and Domestic Violence in the United States. J Surg Res 2020;254:206-16.

Johri M, Morales RE, Boivin JF, et al. Increased risk of miscarriage among women experiencing physical or sexual intimate partner violence during pregnancy in Guatemala City, Guatemala: cross-sectional study. BMC Pregnancy Childbirth 2011;11:49.

Ogrodnik C, Borzutzky S. Women under attack: violence and poverty in Guatemala. J Int Women’s Studies 2011;12.

Halvorsen R. Women caught in a culture of violence in Guatemala. Nurs Women’s Health 2014;18:425-8.

Arreola-Risa C, Mock C, Vega Rivera F, et al. Evaluating trauma care capabilities in Mexico with the World Health Organization’s Guidelines for Essential Trauma Care publication. Rev Panam Salud Publica 2006;19:94-103.

Mock C, Joshipura M, Quansah R, Arreola-Risa C. Advancing injury prevention and trauma care in North America and globally. Surg Clin North Am 2007;87:1-19.

Arreola-Risa C, Vargas J, Contreras I, Mock C. Effect of emergency medical technician certification for all prehospital personnel in a Latin American city. J Trauma 2007;63:914-9.

Morgenstern H. Ecologic Studies in Epidemiology: Concepts, Principles, and Methods. Ann Review Public Health 1995;16:61-81.

Tong S. Migration bias in ecologic studies. Eur J Epidemiol 2000;16:365-9.

Fischer EF, Victor B. High-end coffee and smallholding growers in Guatemala. Latin Am Res Rev 2014;49:155-77.

Butler-Dawson J, Krisher L, Asensio C, et al. Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala. J Occup Environ Med 2018;60:548-58.

Verité, United States Department of Labor. Research on indicators of forced labor in the supply chain of coffee in Guatemala. United States Department of Labor. Accessed December 10, 2020. https://www.verite.org/wp-content/uploads/2016/11/Research-on-Indicators-of-Forced-Labor-in-the-Guatemala-Coffee-Sector__9.16.pdf

Greenland S, Brenner H. Correcting for non-differential misclassification in ecologic analyses. J Royal Statistical Soc Series C (Applied Statistics) 1993;42:117-26.

Guthrie KA, Sheppard L. Overcoming biases and misconceptions in ecological studies. J Royal Statistical Society: Series A (Statistics in Society) 2001;164:141-54.

Svenson, E., Sheth, A. ., Schmidt, J., Tun, R., & Svenson, J. E. (2022). A retrospective analysis of emergency department usage in rural and semi-urban indigenous Guatemalan populations. Healthcare in Low-Resource Settings, 10(1). https://doi.org/10.4081/hls.2022.10256

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