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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone
PLoS ONE, Volume 7, No. 9, Article e41458, Year 2012
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Description
Background: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607) lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. Conclusions: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings. © 2012 Clark et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3446969/bin/pone.0041458.s001.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC3446969/bin/pone.0041458.s002.tif
https://efashare.b-cdn.net/share/pmc/articles/PMC3446969/bin/pone.0041458.s003.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3446969/bin/pone.0041458.s004.pdf
Authors & Co-Authors
Clark, Matthew
United Kingdom, London
Imperial College Healthcare Nhs Trust
Spry, Emily
United Kingdom, London
Welbodi Partnership
Daoh, Kisito S.
Sierra Leone
Minstry of Health and Sanitation
Baion, David
Sierra Leone
Ola During Children's Hospital
Skordis, Jolene
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Statistics
Citations: 36
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0041458
e-ISSN:
19326203
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Study Approach
Qualitative
Study Locations
Sierra Leone