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Implementing WHO hospital guidelines improves quality of paediatric care in central hospitals in Lao PDR
Amy Zigrida Gray1, Douangdao Soukaloun, Bandith Soumphonphakdy
1Centre for International Child Health, University of Melbourne, Melbourne, Vic., Australia.
Insights
Implementing the WHO Pocketbook of Hospital Care for Children improved pediatric case management for common illnesses in Lao PDR hospitals. Key interventions enhanced care for pneumonia, diarrhea, and low birthweight cases.
Area of Science:
- Global Health
- Pediatric Medicine
- Healthcare Quality Improvement
Background:
- Childhood illnesses pose a significant burden in low-resource settings.
- Standardized guidelines are crucial for effective hospital-based pediatric care.
- The WHO Pocketbook of Hospital Care for Children offers evidence-based recommendations.
Purpose of the Study:
- To assess the impact of a multifaceted intervention using the WHO Pocketbook.
- To evaluate improvements in case management quality for common childhood illnesses.
- To measure changes in hospital care practices in Lao PDR.
Main Methods:
- A mixed-methods study was conducted in three central hospitals in Lao PDR.
- Case management quality was assessed before and after intervention implementation.
- Medical record abstraction analyzed over 600 admissions for four sentinel conditions.
Main Results:
- Significant improvements in case management scores were noted for pneumonia, diarrhea, and low birthweight.
- Appropriate drug prescribing, IV fluid use, and patient monitoring increased post-intervention.
- Non-recommended practices, like antitussive prescription, decreased.
Conclusions:
- The WHO Pocketbook intervention effectively enhanced pediatric care quality in Lao hospitals.
- Improvements varied by specific childhood illness.
- Standardized guidelines can drive better clinical outcomes in resource-limited settings.
Objectives:
To evaluate the impact of implementing a multifaceted intervention based on the WHO Pocketbook of Hospital Care for Children on the quality of case management of common childhood illnesses in hospitals in Lao PDR.
Methods:
The quality of case management of four sentinel conditions was assessed in three central hospitals before and after the implementation of the WHO Pocketbook as part of a broader mixed-methods study. Data on performance of key steps in case management in more than 600 admissions were collected by medical record abstraction pre- and post-intervention, and change was measured according to the proportion of cases which key steps were performed as well as an overall score of case management for each condition.
Results:
Improvements in mean case management scores were observed post-intervention for three of the four conditions, with the greatest change in pneumonia (53-91%), followed by diarrhoea and low birthweight. Rational drug prescribing, appropriate use of IV fluids and appropriate monitoring all occurred more frequently post-intervention. Non-recommended practices such as prescription of antitussives became less frequent.
Conclusions:
A multifaceted intervention based on the WHO Pocketbook of Hospital Care for children led to better paediatric care in central Lao hospitals. The degree of improvement was dependent on the condition assessed.
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