Decreased Pediatric Hospital Mortality After an Intervention to Improve Emergency Care in Lilongwe, Malawi
- 1 September 2012
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 130 (3), e676-e682
- https://doi.org/10.1542/peds.2012-0026
Abstract
BACKGROUND AND OBJECTIVE: Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in the developing world. This deficiency contributes to high inpatient mortality rates, particularly early during hospitalization. Our referral hospital in Lilongwe, Malawi, experiences high volume, acuity, and mortality rates. The entry point to our hospital for most children presenting with acute illness is the Under-5 Clinic. We hypothesized that early inpatient mortality and total inpatient mortality rates would decrease with an intervention to prioritize and improve pediatric emergency care at our hospital. METHODS: We implemented the following changes as part of our intervention: (1) reallocation of senior-level clinical support from other areas of the hospital to the Under-5 Clinic for supervision of emergency care, (2) institution of a formal triage process that improved patient flow, and (3) treatment and stabilization of patients before transfer to the inpatient ward. We compared early inpatient and total inpatient mortality rates before and after the intervention. RESULTS: After the intervention, early mortality decreased from 47.6 to 37.9 deaths per 1000 admissions (relative risk 0.80, 95% confidence interval 0.67–0.93). Total mortality also decreased from 80.5 to 70.5 deaths per 1000 admissions after the intervention (relative risk 0.88, 95% confidence interval 0.78–0.98). CONCLUSIONS: Simple, inexpensive interventions to improve pediatric emergency care at this underresourced hospital in sub-Saharan Africa were associated with decreased hospital mortality rates. The description of this process and the associated results may influence practice and resource allocation strategies in similar clinical environments.This publication has 20 references indexed in Scilit:
- Implementing locally appropriate guidelines and training to improve care of serious illness in Kenyan hospitals: a story of scaling-up (and down and left and right)Archives of Disease in Childhood, 2011
- Task shifting: the answer to the human resources crisis in Africa?Human Resources for Health, 2009
- Emergency care for children in resource-constrained countriesTransactions of the Royal Society of Tropical Medicine and Hygiene, 2009
- The Pediatric AIDS Corps: Responding to the African HIV/AIDS Health Professional Resource CrisisPEDIATRICS, 2009
- Global Initiatives for Improving Hospital Care for Children: State of the Art and Future ProspectsPediatrics, 2008
- Improving triage and emergency care for children reduces inpatient mortality in a resource-constrained settingBulletin of the World Health Organization, 2006
- The Metrics of the Physician Brain DrainThe New England Journal of Medicine, 2005
- Improving the quality of paediatric care in peripheral hospitals in developing countriesArchives of Disease in Childhood, 2003
- Expanding access to priority health interventions: a framework for understanding the constraints to scaling‐upJournal of International Development, 2003
- Evaluation of guidelines for emergency triage assessment and treatment in developing countriesArchives of Disease in Childhood, 1999