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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Decreased pediatric hospital mortality after an intervention to improve emergency care in Lilongwe, Malawi
Pediatrics, Volume 130, No. 3, Year 2012
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Description
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. Copyright © 2012 by the American Academy of Pediatrics.
Authors & Co-Authors
Robison, Jeff A.
United States, Salt Lake City
The University of Utah
Malawi, Lilongwe
Texas Children's Hospital
Malawi, Lilongwe
Kamuzu Central Hospital
Ahmad, Zahida P.
Malawi, Lilongwe
Kamuzu Central Hospital
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Nosek, Carl A.
Malawi, Lilongwe
Texas Children's Hospital
Malawi, Lilongwe
Kamuzu Central Hospital
United States, San Francisco
University of California, San Francisco
Durand, Charlotte
Malawi, Lilongwe
Kamuzu Central Hospital
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
Namathanga, Annie
Malawi, Lilongwe
Kamuzu Central Hospital
Milazi, Robert
Malawi, Lilongwe
Kamuzu Central Hospital
Thomas, Ann
Malawi, Lilongwe
Texas Children's Hospital
United States, Washington, D.c.
The George Washington University
Soprano, Joyce V.
United States, Salt Lake City
The University of Utah
Mwansambo, Charles C.V.
Malawi, Lilongwe
Kamuzu Central Hospital
Kazembe, Peter Nicholas
Malawi, Lilongwe
Baylor College of Medicine Children's Foundation Malawi
Torrey, Susan B.
Malawi, Lilongwe
Texas Children's Hospital
United States, New York
New York University
Statistics
Citations: 81
Authors: 11
Affiliations: 9
Identifiers
Doi:
10.1542/peds.2012-0026
ISSN:
00314005
e-ISSN:
10984275
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Study Locations
Malawi