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Exploring healthcare providers' perspectives of the paediatric discharge process in Uganda: a qualitative exploratory
Brooklyn Nemetchek1, Asif Khowaja2, Anthony Kavuma3
1College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Insights
Healthcare providers in Uganda identified significant barriers to effective pediatric discharge, including poor caregiver education and communication gaps. Implementing standardized national policies and community follow-up is crucial for improving child survival post-hospitalization.
Area of Science:
- Global Health
- Pediatric Medicine
- Health Systems Research
Background:
- Childhood mortality disproportionately affects low- and middle-income countries.
- The critical post-discharge period for pediatric patients is under-researched, despite high mortality rates.
- Healthcare provider perspectives on pediatric discharge are vital for understanding system gaps.
Purpose of the Study:
- To explore healthcare providers' and administrators' views on pediatric discharge processes in Uganda.
- To identify current procedures, barriers, facilitators, and perceived importance of discharge planning.
- To gather insights for improving the transition from hospital to home for children.
Main Methods:
- Qualitative exploratory study utilizing focus groups and in-depth interviews.
- Conducted across seven hospitals providing pediatric care in Uganda.
- Involved healthcare providers and facility administrators.
Main Results:
- Current pediatric discharge procedures often rely on hospital protocols or clinician opinions, not national guidelines.
- Key barriers include caregiver limitations, communication failures, traditional practices, and resource shortages.
- Teamwork and motivation were identified as facilitators for implementing proposed changes.
Conclusions:
- Despite systemic challenges, participant insights offer a foundation for improving pediatric discharge.
- A standardized national policy, comprehensive education, and community follow-up are essential for better child outcomes.
- This research can inform interventions to enhance post-discharge care in Uganda and similar contexts.
Introduction:
The burden of childhood mortality continues to be born largely by low-income and middle-income countries. The critical postdischarge period has been largely neglected despite evidence that mortality rates during this period can exceed inpatient mortality rates. However, there is a paucity of data on the paediatric discharge process from the perspective of the healthcare provider. Provider perspectives may be important in the development of an improved understanding of the barriers and facilitators to improving the transition from hospital to home.
Objectives:
To explore healthcare providers' and facility administrators' perspectives of the paediatric discharge process with respect to: (1) current procedures, (2) barriers and challenges, (3) ideas for change, (4) facilitators for change and (5) the importance of discharge planning.
Design:
A qualitative exploratory approach using focus groups (14) and in-depth interviews (7).
Setting:
This study was conducted at seven hospitals providing paediatric care in Uganda.
Results:
Current discharge procedures are largely based on hospital-specific protocols or clinician opinion, as opposed to national guidelines. Some key barriers to an improved discharge process included caregiver resources and education, critical communication gaps, traditional practices, and a lack of human and physical resources. Teamwork and motivation to see improved paediatric transitions to home were identified as facilitators to implementing the ideas for change proposed by participants. The need for a standardised national policy guiding paediatric discharges, implemented through education at many levels and coupled with appropriate community referral and follow-up, was broadly perceived as essential to improving outcomes for children.
Conclusions:
Although significant challenges and gaps were identified within the current health system, participants' ideas and the identified facilitators provide a significant basis from which change may occur. This work can facilitate the development of sustainable and effective interventions to improve postdischarge outcomes in Uganda and other similar settings.
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