Challenges of Prehospital and Hospital-Based Medical and Surgical Emergencies in Sub-Saharan Africa: a Narrative Literature Review: Les Défis Liés aux Urgences Médicales et Chirurgicales Préhospitalières et Hospitalières en Afrique Subsaharienne : une Revue Narrative de la Littérature

Abdel Nacer Amoukou Issaka; Amadou Bouba Traoré Hassane; Nouhou Diori Adam; Roukayatou Karimou Issaka; Laminou Laouali; Abba Kaka; Amza Abdou

doi:10.5281/zenodo.20731046

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Abstract

Introduction. Health systems in Sub-Saharan Africa (SSA) face an increasing burden of medical and surgical emergencies, exacerbated by structural, organizational, and human challenges. This narrative review aimed to analyze the systemic difficulties in emergency care at both prehospital and hospital levels. Methods. A comprehensive literature review was conducted between September 2023 and January 2024 across PubMed, African Journals OnLine, and Google Scholar, focusing on publications from 2012 to 2023 on emergency care in SSA. Results. The analysis reveals critical gaps in the prehospital care chain, characterized by a lack of structured Emergency Medical Services (EMS), inadequate transportation, and prolonged transit times. At the hospital level, emergency departments face overcrowding, excessive wait times, chronic shortages of qualified personnel and material resources, and financial barriers to care. These dysfunctions lead to high avoidable morbidity and mortality, with emergency department death rates exceeding 11 % in some studies. Urban-rural disparities further aggravate inequalities in access. Conclusion. There is a significant gap between current SSA practices and international standards. Strategic reforms, including human resource strengthening, optimization of care pathways, and development of innovative, context-specific care models, are imperative to improve survival and quality of life in the region.

Keywords

medical and surgical emergencies, Sub-Saharan Africa, prehospital care, emergency medicine, health systems urgences médicales et chirurgicales, Afrique subsaharienne, soins préhospitaliers, médecine d'urgence, systèmes de santé

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Abdel Nacer Amoukou Issaka, Amadou Bouba Traoré Hassane, Nouhou Diori Adam, Roukayatou Karimou Issaka, Laminou Laouali, Abba Kaka, & Amza Abdou. (2026). Challenges of Prehospital and Hospital-Based Medical and Surgical Emergencies in Sub-Saharan Africa: a Narrative Literature Review: Les Défis Liés aux Urgences Médicales et Chirurgicales Préhospitalières et Hospitalières en Afrique Subsaharienne : une Revue Narrative de la Littérature. HEALTH SCIENCES AND DISEASE, 27(7), 28–32. https://doi.org/10.5281/zenodo.20731046

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References

1. World Health Organization Regional Office for Africa. 2022 African Health Statistics Atlas: Analysis of the health situation in the African Region — Summary report. Brazzaville: WHO Regional Office for Africa; 2022.
2. World Health Organization Regional Office for Africa. Ensuring health security in the African Region: Flagship projects in emergency preparedness and response. Brazzaville: WHO Regional Office for Africa; 2022.
3. World Health Organization Regional Office for Africa. Ensuring health security in the African Region. Quarterly Report #1 March 2023. Brazzaville: WHO Regional Office for Africa; 2023.
4. Nkoua-Gomed F, Toure A, Ndong A, Leye YM, Diop M, Gassama O, et al. Prevalence and mortality rate of abdominal surgical emergencies in adults in sub-Saharan Africa: a systematic review and meta-analysis. Pan Afr Med J. 2023;46:173.
5. Reynolds TA, Calvello EJB, Sakita F, Mfinanga J, Wallis LA. Sub-Saharan African emergency care systems. Afr J Emerg Med. 2020;10(Suppl 1):S2-S4.
6. Calvello EJB, Reynolds T, Hirshon JM, Mfinanga J, Mbibi A, Milinga J, et al. Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy. 2013;34(Suppl 1):S116-27.
7. Zoumenou E, Lokossou TC, Assouto P, Soton F, Chobli MK. Critical analysis of mortality in an emergency department in sub-Saharan Africa: epidemiology and perspectives for reduction. Ann Fr Anesth Reanim. 2014;33(S1):A205.
8. Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(4):355-362.
9. Godard K. African cities facing the urban mobility crisis. Africa Transport Policy Program (SSATP); 2019.
10. Agossou T, Fournet F, Lapeyre N. The accessibility of rural populations to primary health care in Benin. Espace populations sociétés. 2012/1(1):109-121.
11. Kouamé G, Da S, Kambiré J, Ouattara A, Sanou A. Factors influencing the delay in management at the surgical emergencies of the Sourô Sanou University Hospital. Santé Publique. 2024;36(2):109-117.
12. M'benda A, M'bortche B, Agbéti-Afiademanyo K, Kotosso A. Management of overcrowding in the Emergency Department of the Sylvanus Olympio University Hospital in Lomé. Pan Afr Med J. 2022;41:63.
13. Some D, Zoungrana J, Ky S, Nagalo K, Ouedraogo S, Zida M, et al. Factors influencing the delay in management at the surgical emergencies of the CHU Souro Sanou. ResearchGate. 2024.
14. Okoue Ondo R, Edjo Nkilly G, Oliveira S, Antchandie A, Sagbo V, Matsanga A, et al. Factors of Early Mortality in Hospital Emergencies in Libreville: A Monocentric Prospective Study. Health Sci Dis. 2025;26(12):69-78.
15. World Health Organization Regional Office for Africa. Chronic staff shortages hinder health systems in Africa, according to a WHO study. Brazzaville: WHO; 2022.
16. Web-saraf.net. Constraints on the management of medical and surgical emergencies in Africa. [Accessed February 10, 2026].
17. Kras E. emergency medicine in limited resource countries: practical manual. 2nd edition. Marseille: Santé Sud; 2024.
18. Ridde V. Challenges of universal health coverage in sub-Saharan Africa: permanence and failures of New Public Management instruments. In: Challenges of universal health coverage in sub-Saharan Africa. Science et bien commun; 2022.
19. Yao LB, Akobe AJR, M´Bra KI, Sery BJLN, Kouassi JEK, Kouassi AAN, et al. Reasons for refusal and abandonment of care at the surgical emergencies of the Bouaké University Hospital Center, Ivory Coast. Pan Afr Med J. 2021;38:291.
20. Countdown to 2030. Urban Health. [Accessed February 10, 2026].
21. Jayaraman S, Ayalew S, Konda S, Melesse T, D'Ambruoso L, Hussien A, et al. Hospital disaster preparedness in sub-Saharan Africa: a systematic review. BMJ Open. 2023;13(6):e070185.
22. African Federation for Emergency Medicine. The African Journal of Emergency Medicine (AfJEM). [Accessed February 10, 2026].

References

1. World Health Organization Regional Office for Africa. 2022 African Health Statistics Atlas: Analysis of the health situation in the African Region — Summary report. Brazzaville: WHO Regional Office for Africa; 2022.

2. World Health Organization Regional Office for Africa. Ensuring health security in the African Region: Flagship projects in emergency preparedness and response. Brazzaville: WHO Regional Office for Africa; 2022.

3. World Health Organization Regional Office for Africa. Ensuring health security in the African Region. Quarterly Report #1 March 2023. Brazzaville: WHO Regional Office for Africa; 2023.

4. Nkoua-Gomed F, Toure A, Ndong A, Leye YM, Diop M, Gassama O, et al. Prevalence and mortality rate of abdominal surgical emergencies in adults in sub-Saharan Africa: a systematic review and meta-analysis. Pan Afr Med J. 2023;46:173.

5. Reynolds TA, Calvello EJB, Sakita F, Mfinanga J, Wallis LA. Sub-Saharan African emergency care systems. Afr J Emerg Med. 2020;10(Suppl 1):S2-S4.

6. Calvello EJB, Reynolds T, Hirshon JM, Mfinanga J, Mbibi A, Milinga J, et al. Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy. 2013;34(Suppl 1):S116-27.

7. Zoumenou E, Lokossou TC, Assouto P, Soton F, Chobli MK. Critical analysis of mortality in an emergency department in sub-Saharan Africa: epidemiology and perspectives for reduction. Ann Fr Anesth Reanim. 2014;33(S1):A205.

8. Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(4):355-362.

9. Godard K. African cities facing the urban mobility crisis. Africa Transport Policy Program (SSATP); 2019.

10. Agossou T, Fournet F, Lapeyre N. The accessibility of rural populations to primary health care in Benin. Espace populations sociétés. 2012/1(1):109-121.

11. Kouamé G, Da S, Kambiré J, Ouattara A, Sanou A. Factors influencing the delay in management at the surgical emergencies of the Sourô Sanou University Hospital. Santé Publique. 2024;36(2):109-117.

12. M'benda A, M'bortche B, Agbéti-Afiademanyo K, Kotosso A. Management of overcrowding in the Emergency Department of the Sylvanus Olympio University Hospital in Lomé. Pan Afr Med J. 2022;41:63.

13. Some D, Zoungrana J, Ky S, Nagalo K, Ouedraogo S, Zida M, et al. Factors influencing the delay in management at the surgical emergencies of the CHU Souro Sanou. ResearchGate. 2024.

14. Okoue Ondo R, Edjo Nkilly G, Oliveira S, Antchandie A, Sagbo V, Matsanga A, et al. Factors of Early Mortality in Hospital Emergencies in Libreville: A Monocentric Prospective Study. Health Sci Dis. 2025;26(12):69-78.

15. World Health Organization Regional Office for Africa. Chronic staff shortages hinder health systems in Africa, according to a WHO study. Brazzaville: WHO; 2022.

16. Web-saraf.net. Constraints on the management of medical and surgical emergencies in Africa. [Accessed February 10, 2026].

17. Kras E. emergency medicine in limited resource countries: practical manual. 2nd edition. Marseille: Santé Sud; 2024.

18. Ridde V. Challenges of universal health coverage in sub-Saharan Africa: permanence and failures of New Public Management instruments. In: Challenges of universal health coverage in sub-Saharan Africa. Science et bien commun; 2022.

19. Yao LB, Akobe AJR, M´Bra KI, Sery BJLN, Kouassi JEK, Kouassi AAN, et al. Reasons for refusal and abandonment of care at the surgical emergencies of the Bouaké University Hospital Center, Ivory Coast. Pan Afr Med J. 2021;38:291.

20. Countdown to 2030. Urban Health. [Accessed February 10, 2026].

21. Jayaraman S, Ayalew S, Konda S, Melesse T, D'Ambruoso L, Hussien A, et al. Hospital disaster preparedness in sub-Saharan Africa: a systematic review. BMJ Open. 2023;13(6):e070185.

22. African Federation for Emergency Medicine. The African Journal of Emergency Medicine (AfJEM). [Accessed February 10, 2026].

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Challenges of Prehospital and Hospital-Based Medical and Surgical Emergencies in Sub-Saharan Africa: a Narrative Literature Review

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