ASSESSMENT OF QUALITY OF CARE OF SICK UNDER-FIVE CHILDREN IN REFERRAL HOSPITALS IN ETHIOPIA

Abstract

Background: About 10-20% of sick children presenting to a primary care facility require referral to hospital for inpatient care. Improvement of the quality of pediatric referral care has a major contribution to the child survival efforts by ensuring the continuum of care and averting mortality.

Objective: To assess the quality of care for children in selected referral hospitals based on the minimum standards derived from the “WHO Pocket book of Hospital Care for Children, 2005” and thereby to initiate pediatric referral care quality improvement process in the country.
Methods: A qualitative assessment of pediatric referral care was conducted in 8 hospitals selected by convenient sampling, January – July 2008. A team composed of experienced pediatricians and health officer used an adapted WHO hospital assessment tool to assess the quality of triage, emergency care and case management practices & hospital infrastructure and support services.
Results: None of these hospitals were practicing the standard triaging process by assessing children immediately on arrival for emergency and priority signs. All of them were not appropriately organized and fully equipped to handle  pediatric emergencies effectively. Overall, the case management of common neonatal and childhood illnesses was not optimal. Generally, there was shortage of some essential drugs and lack of materials such as nasal prongs, infant and child size bag & masks, nebulizers, heaters and oxygen concentrators. Hygienic facilities were below the expected standard. Staff were not trained in ETAT (Emergency Triage Assessment and Treatment) and there were no protocols for pediatric referral care. There was no clearly designated high dependency area where very sick children receive highest attention and no special rooms for providing appropriate neonatal care in majority of the hospitals. The overall case fatality rate was 11% (10-16%) but first 24 hours mortality could not be determined due to problems with the recording system.

Conclusions: The quality of pediatric referral care needs serious attention and coordinated efforts utilizing the opportunity of the national hospital management initiative and the BPR (Business Process Re-engineering) to institutionalize ETAT and standards of hospital care for children. This has to be complemented with availing of appropriate job aids, essential supplies and equipments, and improvement of health worker skills through training, clinical mentoring and regular supportive supervision.