Emergency care provision and treatment outcomes among under-five children at Mangochi District Hospital
Kamuzu University of Health Sciences
WHO/UNICEF developed ETAT guidelines to help improve child survival. Mangochi hospital adopted ETAT in 2009. The hospital’s status of pediatric emergency care was unknown. The aim of the study was to determine characteristics of users, care provided, and outcomes of the admitted children. This was an uncontrolled before and after study design, conducted to assess pediatric emergencies before and after an intervention in pediatrics’ department for the under-five children, Mangochi, Malawi. The pre-and post-intervention file reviews done retrospectively. The pre was a baseline and followed by a second review following an intervention described below. A checklist developed in line with WHO ETAT guidelines. The tool assesses general socio-demographic, vital signs, triage, laboratory investigations, and availability of basic functional equipment, diagnosis, drug treatment, and patient’s outcome. Descriptive statics were used to analyze continuous and categorical variables. P below .05 was considered significant. The ethical clearance was granted by College of Medicine Research Ethics Committee (COMREC #: P.04/17/2140) after authorization by the local district assembly. Patient gave an informed consent to participate to the study and data were collected anonymously and kept confidential. There was significant increase in all vital signs’ recording post- intervention, except for respiratory rate (p= 0.484). Majority of participants were not triaged (64% vs. 75% respectively). The diagnosis percentages of severe malaria with anemia (12% vs. 0%, p<0.0001), and of severe malaria with severe pneumonia (6.4% vs. 0%, p< 0.0001) decreased significantly. Severe pneumonia (19.7% vs. 29.3%, p< 0.0001), severe head injuries (0.3% vs. 1%; p= 0.0050), sepsis (1.7% vs. 9.0%, p< 0.0001), and unknown conditions (0.3% vs. 1%; p= 0.0050) increased significantly. Initial prescribed drugs were promptly administered (98% vs. 100%). There was a significant decrease of deaths (14.3% to 2%; p< 0.0001), and absconders (5.3% to 0.3%; p=0.0002) post-intervention. Even if results are mixed, most parameters improved following our intervention. Interventions to improve the knowledge of health workers in ETAT coupled with the provision of medical equipment and supplies, improved outcomes are warranted. Challenges in triage need to be investigated further and addressed accordingly.