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Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone
M De Bruycker1, R Van den Bergh1, A Dahmane1
1Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
Insights
High non-adherence to malaria and lower respiratory tract infection (LRTI) treatment guidelines in a Sierra Leone hospital significantly impacts patient outcomes. Improving rational drug use is crucial for better clinical care.
Area of Science:
- Global health
- Paediatric medicine
- Pharmacovigilance
Background:
- Non-rational medicine use is a significant global health issue.
- Standard treatment guidelines (STGs) aim to ensure optimal patient care.
- Adherence to STGs in resource-limited settings is often suboptimal.
Purpose of the Study:
- To evaluate adherence to STGs for malaria and lower respiratory tract infection (LRTI) in children.
- To determine the relationship between guideline adherence and hospital outcomes.
- To highlight the impact of non-rational medicine use on paediatric care.
Main Methods:
- Secondary analysis of routine programme data from a rural paediatric hospital in Bo, Sierra Leone.
- Inclusion of data for 865 children with malaria and 690 with LRTI (January-April 2011).
- Assessment of non-adherence based on drug regimens, dosage, frequency, and duration.
Main Results:
- High cumulative non-adherence for LRTI (86%) and malaria (12%) cases.
- Non-adherence included deviations in drug regimens, dosage, frequency, and duration.
- Potentially harmful non-adherence was significantly linked to adverse hospital outcomes for both conditions.
Conclusions:
- Clinician non-adherence to STGs is prevalent in routine hospital settings and affects patient outcomes.
- There is a critical need for monitoring and improving rational drug use in paediatric care.
- Implementing routine measures is essential to enhance the quality of clinical care in similar hospitals.
Setting:
A rural paediatric hospital in Bo, Sierra Leone.
Objectives:
To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem.
Design:
Secondary analysis of routine programme data.
Results:
Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases.
Conclusions:
Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.
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