TY - JOUR
T1 - Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network
AU - Rees, Chris A.
AU - Igunza, Kitiezo Aggrey
AU - Madewell, Zachary J.
AU - Akelo, Victor
AU - Onyango, Dickens
AU - El Arifeen, Shams
AU - Gurley, Emily S.
AU - Hossain, Mohammad Zahid
AU - Rahman, Afruna
AU - Alam, Muntasir
AU - Scott, J. Anthony G.
AU - Assefa, Nega
AU - Madrid, Lola
AU - Belachew, Anteneh
AU - Leulseged, Haleluya
AU - Kotloff, Karen L.
AU - Sow, Samba O.
AU - Tapia, Milagritos D.
AU - Keita, Adama Mamby
AU - Sidibe, Diakaridia
AU - Sitoe, Antonio
AU - Varo, Rosauro
AU - Ajanovic, Sara
AU - Bassat, Quique
AU - Mandomando, Inácio
AU - Tippett Barr, Beth A.
AU - Ogbuanu, Ikechukwu
AU - Cain, Carrie Jo
AU - Bassey, Ima Abasi
AU - Luke, Ronita
AU - Gassama, Khadija
AU - Madhi, Shabir
AU - Dangor, Ziyaad
AU - Mahtab, Sana
AU - Velaphi, Sithembiso
AU - du Toit, Jeanie
AU - Mutevedzi, Portia C.
AU - Blau, Dianna M.
AU - Breiman, Robert F.
AU - Whitney, Cynthia G.
AU - Solomon, Fatima
AU - Sorour, Gillian
AU - Lombaard, Hennie
AU - Wadula, Jeannette
AU - Petersen, Karen
AU - Hale, Martin
AU - Govender, Nelesh P.
AU - Swart, Peter J.
AU - Lala, Sanjay G.
AU - Chawana, Richard
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1–59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016–June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation: Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding: Bill & Melinda Gates Foundation.
AB - Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1–59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016–June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation: Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding: Bill & Melinda Gates Foundation.
KW - Childhood
KW - Clinical care
KW - Guideline adherence
KW - Mortality
U2 - 10.1016/j.eclinm.2023.102198
DO - 10.1016/j.eclinm.2023.102198
M3 - Article
SN - 2589-5370
VL - 63
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 102198
ER -
