Abstract
Objective
To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India.
Design
Facility-based assessment of district hospitals.
Settings
13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan.
Participants
Staff nurses and doctors.
Intervention
None.
Methods
An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed.
Results
Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8–10%. There was a 65 percent shortfall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities.
Conclusion
The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.
Keywords: Assessment, Childhood illness, Operational guidelines, Quality assurance
Footnotes
Contributors
HK: conceptualized the study and provided overall guidance; AAB,VA: guided the data compilation and supervised different steps involved in the study; RK: compiled and analyzed data of the assessment and supported the drafting of manuscript; SBN: reviewed the literature and drafted the manuscript; HK, AAB, AK, SD: technical inputs in finalizing the manuscript. All the authors have approved the final version of the manuscript.
Funding
Norway India Partnership Initiative (NIPI).
Competing interest
None stated.
References
- 1.Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: An updated systematic analysis. Lancet. 2015;385:430–40. doi: 10.1016/S0140-6736(14)61698-6. [DOI] [PubMed] [Google Scholar]
- 2.Chan M, Lake A. Integrated action for the prevention and control of pneumonia and diarrhoea. Lancet. 2013;381:1436–7. doi: 10.1016/S0140-6736(13)60692-3. [DOI] [PubMed] [Google Scholar]
- 3.Ntoburi S, Hutchings A, Sanderson C, Carpenter J, Weber M, English M. Development of paediatric quality of inpatient care indicators for low-income countries — A Delphi study. BMC Pediatr. 2010;10:90. doi: 10.1186/1471-2431-10-90. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Hategeka C, Mwai L, Tuyisenge L. Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers’ perspectives on relevance and challenges. BMC Hlth Services Res. 2017;17:256. doi: 10.1186/s12913-017-2193-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hoque DME, Rahman M, Billah SM, et al. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh. BMC Pediatr. 2012;12:197. doi: 10.1186/1471-2431-12-197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Campbell H, Duke T, Weber M, et al. Global initiatives for improving hospital care for children: state of the art and future prospects. Pediatrics. 2008;121:e984–e92. doi: 10.1542/peds.2007-1395. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Hategeka C, Shoveller J, Tuyisenge L, Kenyon C, Cechetto DF, Lynd LD. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda. PLoS One. 2017;12:e0173233. doi: 10.1371/journal.pone.0173233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Nolan T, Angos P, Cunha AJ, et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet. 2001;357:106–10. doi: 10.1016/S0140-6736(00)03542-X. [DOI] [PubMed] [Google Scholar]
- 9.Ministry of Health and Family Welfare . India Newborn Action Plan (INAP) New Delhi: Ministry of Health and Family Welfare; 2013. [Google Scholar]
- 10.Ministry of Health and Family Welfare. Operational guidelines for Quality Assurance in public health facilities New Delhi. 2013 [cited 2019 July 15].
- 11.Directorate General of Health Services. Indian Public Health Standards (IPHS)- Guidelines for District Hospitals New Delhi 2012. [cited 2019 March 3].
- 12.English M, Esamai F, Wasunna A, et al. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet. 2004;363:1948–53. doi: 10.1016/S0140-6736(04)16408-8. [DOI] [PubMed] [Google Scholar]
- 13.Muzigaba M, Van Wyk B, Puoane T. Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals. African J Prim Hlth Care Family Med. 2018;10:e1–e8. doi: 10.4102/phcfm.v10i1.1547. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Solnes Miltenburg A, Kiritta RF, Bishanga TB, van Roosmalen J, Stekelenburg J. Assessing emergency obstetric and newborn care: can performance indicators capture health system weaknesses? BMC Preg Childbirth. 2017;17:92. doi: 10.1186/s12884-017-1282-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ministry of Health and Family Welfare. Strengthening Facility Based Paediatric Care. Accessed on February 12, 2019. Available from Government of India; 2015.
- 16.Gathara D, Opiyo N, Wagai J, et al. Quality of hospital care for sick newborns and severely malnourished children in Kenya: a two-year descriptive study in 8 hospitals. BMC health services research. 2011;11:307. doi: 10.1186/1472-6963-11-307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Hategeka C, Shoveller J, Tuyisenge L, Lynd LD. Assessing process of paediatric care in a resource-limited setting: A cross-sectional audit of district hospitals in Rwanda. Paediatr and Int Child Hlth. 2018;38:137–45. doi: 10.1080/20469047.2017.1303017. [DOI] [PubMed] [Google Scholar]
- 18.Enarson PM, Gie RP, Mwansambo CC, et al. Reducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management. PLoS One. 2014;9:e102955–e. doi: 10.1371/journal.pone.0102955. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Menge I, Esamai F, van Reken D, Anabwani G. Paediatric morbidity and mortality at the Eldoret District Hospital, Kenya. East African Med. J. 1995;72:165–9. [PubMed] [Google Scholar]
- 20.Irimu GW, Gathara D, Zurovac D, et al. Performance of health workers in the management of seriously sick children at a Kenyan tertiary hospital: before and after a training intervention. PloS One. 2012;7:e39964–e. doi: 10.1371/journal.pone.0039964. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Mpimbaza A, Sears D, Sserwanga A, et al. Admission risk score to predict inpatient pediatric mortality at four public hospitals in Uganda. PLoS One. 2015;10:e0133950–e. doi: 10.1371/journal.pone.0133950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Ayieko P, Ntoburi S, Wagai J, et al. A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: A cluster randomised trial. PLoS Med. 2011;8:e1001018–e. doi: 10.1371/journal.pmed.1001018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Duke T, Tamburlini G. Improving the quality of paediatric care in peripheral hospitals in developing countries. Arch Dis Childhood. 2003;88:563–5. doi: 10.1136/adc.88.7.563. [DOI] [PMC free article] [PubMed] [Google Scholar]