Quality of hospital care for seriously ill children in less-developed countries

Background improving the quality of care for sick children referred to hosp itals in less-developed countries may lead to better outcomes, including re duced mortality. Data are lacking, however, on the quality of priority scre ening (triage), emergency care, diagnosis, and inpatient treatment in these hospitals, and on aspects of these potential targets that would benefit mo st from interventions leading to improved health outcomes. Methods We did a qualitative study in 13 district hospitals and eight teach ing hospitals in seven less-developed countries. Experienced paediatricians used a structured survey instrument to assess initial triage, emergency an d inpatient care, staff knowledge and practices, and hospital support servi ces. Findings Overall quality of care differed between countries and among hospi tals and was generally better in teaching hospitals. 14 of 21 hospitals lac ked an adequate system for triage. Initial patient assessment was often ina dequate and treatment delayed. Most emergency treatment areas were poorly o rganised and lacked essential supplies; families were routinely required to buy emergency drugs before they could be given. Adverse factors in case ma nagement, including inadequate assessment, inappropriate treatment, and ina dequate monitoring occurred in 76% of inpatient children. Most doctors in d istrict hospitals, and nurses and medical assistants in leaching and distri ct hospitals, had inadequate knowledge and reported practice for managing i mportant childhood illnesses. Interpretation Strengthening care for sick children referred to hospital sh ould focus on achievable objectives with the greatest potential benefit for health outcome. Possible targets for improvement include initial triage, e mergency care, assessment, inpatient treatment, and monitoring. Priority ta rgets for individual hospitals may be determined by assessing each hospital .