Quality of hospital care for seriously ill children in less-developed countries

Terry Nolan, Patria Angos, Antonio J.L.A. Cunha, Lulu Muhe, Shamim Qazi, Eric A.F. Simoes, Giorgio Tamburlini, Martin Weber, Nathaniel F. Pierce

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)106-110
Number of pages5
JournalLancet
Volume357
Issue number9250
DOIs
StatePublished - Jan 13 2001

ASJC Scopus subject areas

  • Medicine(all)

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