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Quality of hospital care for seriously ill children in less-developed countries
1Department of Paediatrics, University of Melbourne and Murdock Children's Research Institute, Royal Children's Hospital, Parkville, Australia.
Insights
Quality of care for sick children in less-developed countries is often poor, with inadequate triage, emergency care, and inpatient treatment. Interventions should target these areas to reduce child mortality.
Area of Science:
- Pediatric Healthcare Quality
- Global Health Equity
- Hospital Management in LMICs
Background:
- Improving pediatric care in less-developed countries is crucial for reducing child mortality.
- Limited data exists on the quality of hospital care for children in these settings.
- Understanding quality gaps in triage, emergency, and inpatient care is essential for targeted interventions.
Purpose of the Study:
- To assess the quality of care for sick children in hospitals in less-developed countries.
- To identify specific areas within hospital care that would benefit most from interventions.
- To provide data for improving health outcomes in pediatric hospital settings.
Main Methods:
- A qualitative study was conducted in 13 district and 8 teaching hospitals across seven less-developed countries.
- Experienced pediatricians utilized a structured survey instrument for assessment.
- Evaluated initial triage, emergency and inpatient care, staff knowledge, practices, and hospital support services.
Main Results:
- Quality of care varied significantly between countries and hospitals, with teaching hospitals generally performing better.
- 14 out of 21 hospitals lacked adequate triage systems; initial assessments were often inadequate, leading to delayed treatment.
- Emergency areas were poorly equipped, and families frequently had to purchase essential drugs.
- Adverse factors in case management affected 76% of inpatients, including inadequate assessment, treatment, and monitoring.
- Healthcare staff in most hospitals demonstrated inadequate knowledge and reported practices for managing childhood illnesses.
Conclusions:
- Strengthening hospital care for sick children requires focusing on achievable objectives with high health impact.
- Key areas for improvement include initial triage, emergency care, patient assessment, inpatient treatment, and monitoring.
- Individual hospital assessments are recommended to determine priority targets for intervention.
Background:
Improving the quality of care for sick children referred to hospitals in less-developed countries may lead to better outcomes, including reduced mortality. Data are lacking, however, on the quality of priority screening (triage), emergency care, diagnosis, and inpatient treatment in these hospitals, and on aspects of these potential targets that would benefit most from interventions leading to improved health outcomes.
Methods:
We did a qualitative study in 13 district hospitals and eight teaching hospitals in seven less-developed countries. Experienced paediatricians used a structured survey instrument to assess initial triage, emergency and inpatient care, staff knowledge and practices, and hospital support services.
Findings:
Overall quality of care differed between countries and among hospitals and was generally better in teaching hospitals. 14 of 21 hospitals lacked an adequate system for triage. Initial patient assessment was often inadequate and treatment delayed. Most emergency treatment areas were poorly organised and lacked essential supplies; families were routinely required to buy emergency drugs before they could be given. Adverse factors in case management, including inadequate assessment, inappropriate treatment, and inadequate monitoring occurred in 76% of inpatient children. Most doctors in district hospitals, and nurses and medical assistants in teaching and district hospitals, had inadequate knowledge and reported practice for managing important childhood illnesses.
Interpretation:
Strengthening care for sick children referred to hospital should focus on achievable objectives with the greatest potential benefit for health outcome. Possible targets for improvement include initial triage, emergency care, assessment, inpatient treatment, and monitoring. Priority targets for individual hospitals may be determined by assessing each hospital.
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