Emergency triage in coastal Kenya: a survey of public Emergency Departments.

Background: Triage is a cornerstone of emergency care, with profound impacts on care prioritization and mortality. However, implementation of structured triage systems across sub-Saharan Africa has been inconsistent, hindered by context-specific challenges. Little is known about the landscape of triage in public emergency departments (EDs) in Kenya. We conducted a cross-sectional survey to characterize triage infrastructure, practices, and staff perceptions across public EDs in coastal Kenya. Methods: In February 2026, trained study staff administered a standardized questionnaire to clinical leaders at all ten public EDs in Kilifi, Kwale, and Mombasa counties. The survey included items on triage infrastructure, staffing, equipment, procedures, and staff perceptions. Data were analyzed descriptively. Results: Nine of ten public EDs (90%) reported performing triage, yet only two (22%) used standardized tools or written protocols, with the remainder relying on clinical judgment. Among the nine EDs performing triage, seven (78%) had a dedicated triage area and seven or more (≥78%) reported adequate availability of equipment for vital sign measurement. Staffing was the most consistently identified barrier to effective triage, cited at eight of nine EDs (89%). Satisfaction with local triage functioning was mixed, with respondents at 67% of EDs (6/9) reporting dissatisfaction. Despite this, all respondents reported that triage as performed locally improves patient care and outcomes. Conclusions: Triage is commonly performed across public EDs in three coastal Kenyan counties but formalized in only a minority of facilities. Consistent clinical leader endorsement of the value of local triage, alongside existing infrastructure, suggests that the foundational elements for effective triage strengthening are present. Reported gaps in standardized tools, training, and nursing staffing represent an actionable agenda for local, county, and national stakeholders. Targeted and sustained efforts to address these gaps, supported by partners operating across and within Kenya's decentralized health care system, offer a significant opportunity to strengthen emergency triage systems and reduce preventable mortality.