ABSTRACT
The study's aim was to evaluate the impact of an in-service training course and supervision of physicians and nurses in terms of quality of care on intra-hospital mortality. The study included 2 cohorts of children. Cohort 1 included 414 children from 0 to 15-years-old who were followed in the paediatric wards of the provincial hospital of Goma (HPG) between April 1, 2003 and March 31, 2004. Cohort 2 included 996 children from 0 to 15-years-old where were treated and followed in the same service between January 1, 2005 and December 31, 2005. General and specific mortalities occurring before and after an intervention were compared, as were the ratios of the observed deaths to the predicted deaths through the application of the Goma1 model to cohort 2. Overall mortality decreased by 15,9% (before the intervention) to 4,6% (after the intervention), translating to a total reduction of 71,1%. The ratios between the observed deaths and the predicted deaths were lower than 1, globally and when stratified. The risk of death in the cohort 1 (before the intervention) is 6,8 times higher than in cohort 2 (after the intervention). This shows an improvement of child survival after the intervention.
Subject(s)
Hospital Mortality/trends , Hospitals, Pediatric/standards , Inservice Training , Quality of Health Care , Adolescent , Africa, Central , Child , Child, Hospitalized , Child, Preschool , Cohort Studies , Confidence Intervals , Data Interpretation, Statistical , Follow-Up Studies , Humans , Infant , Infant, Newborn , Organization and Administration/standards , Time FactorsABSTRACT
The aim of this study is to describe the quality of care provided to children hospitalized in the provincial hospital of Goma (HPG) and to identify the risk factors in the management of care, especially those which can contribute to a poor or inaccurate prognosis, and to uncover and show any inadequacies in care management. The data were collected with the use of a structured questionnaire updated by Nolan in 2001. The study allowed us to look at the initial assessment of incoming patients and to describe the quality of triage, emergency care, diagnosis, inpatient care, staff knowledge and practices, hospitals support services and any factors related to these that may lead to negative outcomes. The level of the severity of the illness and a late diagnosis were risk factors identified for mortality. The quality of care provided to the children during the day was high and good; however, night time care was insufficient. It was noted that nurses were found to lack adequate knowledge.
Subject(s)
Pediatrics , Quality of Health Care , Child , Child, Preschool , Democratic Republic of the Congo , Hospitals , Humans , Infant , Infant, Newborn , Severity of Illness IndexABSTRACT
OBJECTIVES: To find a simple mortality prediction model based on nutritional and infection indicators for the assessment of the care of children admitted to hospital in central Africa. METHOD: Cohort study of 414 children admitted at Goma Hospital between 1.4.2003 and 31.3.2004. We conducted univariate analysis and logistic regression, computed adjusted odds ratios and constructed a prognostic score from the coefficients of logistic regression. The performance of logistic model and score were evaluated by the calculation of areas under the ROC curves. RESULTS: The intrahospital mortality rate reached 15.9%. In univariate analysis, age, WAZ, arm circumference, neurological status (Blantyre coma score), stiff neck, subcostal indrawning, and infection were significantly associated with mortality. Logistic regression model analysis and adjusted odds ratios (AOR) confirmed higher risks of death for young (AOR 3.4 (1.4-8.8) and underweight children (WAZ -2->-3 and WAZ < or = -3, AOR 3.2 (1.4-7.6) and AOR 4.4 (1.7-11.2)), for children with arm circumference under 115 mm (AOR 3.4 (1.5-7.3)), impaired consciousness (AOR 9.6 (3.1-29.9)) and bloodstream infections (AOR 6.6 (2.1-21.1)). The area under the ROC curve of the prognostic model is 0.83 (0.78-0.88), that of the prognostic score, 0.80 (0.75-0.86). CONCLUSION: This study provides a simple mortality prediction model for hospitalised children in central Africa, based on age, weight for age or arm circumference, neurological status (Blantyre coma score), and infection. This model and scoring system can be used to evaluate programs set up to reduce intrahospital mortality in this region.
