Performance of Health Workers in the Management of Seriously Sick Children at a Kenyan Tertiary Hospital Before and after a Training Intervention 英文参考文献.docVIP

Performance of Health Workers in the Management of Seriously Sick Children at a Kenyan Tertiary Hospital Before and after a Training Intervention 英文参考文献.doc

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Performance of Health Workers in the Management of Seriously Sick Children at a Kenyan Tertiary Hospital Before and after a Training Intervention 英文参考文献

PerformanceofHealthWorkersintheManagementof SeriouslySickChildrenataKenyanTertiaryHospital: BeforeandafteraTrainingIntervention GraceW.Irimu1,2*,DavidGathara2,DejanZurovac2,3,4,HarrisonKihara5,ChristopherMaina5, JuliusMwangi5,DorothyMbori-Ngacha1,JimTodd6,AlexandraGreene7,MikeEnglish1,2,8 1DepartmentofPaediatricsandChildHealth,CollegeofHealthSciences,UniversityofNairobi,Nairobi,Kenya,2CentreforGeographicMedicineResearch–Coast,KEMRI/ WellcomeTrustResearchProgramme,Kilifi,Kenya,3CentreforTropicalMedicine,NuffieldDepartmentofClinicalMedicine,UniversityofOxford,Oxford,UnitedKingdom, 4CenterforGlobalHealthandDevelopment,BostonUniversity,Boston,Massachusetts,UnitedStatesofAmerica,5KenyattaNationalHospital,Nairobi,Kenya,6London School of Hygiene and Tropical Medicine, London, United Kingdom, 7Child Health, University of Dundee, Dundee, United Kingdom, 8Department of Paediatrics, UniversityofOxford,Oxford,UnitedKingdom Abstract Background: Implementation of WHO case management guidelines for serious common childhood illnesses remains a challenge in hospitals in low-income countries. The impact of locally adapted clinical practice guidelines (CPGs) on the quality-of-careofpatientsintertiaryhospitalshasrarelybeenevaluated. Methods and Findings: We conducted, in Kenyatta National Hospital, an uncontrolled before and after study with an attempt to explore intervention dose-effect relationships, as CPGs were disseminated and training was progressively implemented.Theemergencytriage,assessmentandtreatmentplusadmissioncare(ETAT+)trainingandlocallyadapted CPGstargetedcommon,seriouschildhoodillnesses.Wecomparedperformanceinthepre-intervention(2005)andpost- interventionperiods(2009)usingqualityindicatorsforthreediseases:pneumonia,dehydrationandseveremalnutrition.The indicatorsspannedfourdomainsinthecontinuumofcarenamelyassessment,classification,treatment,andfollow-upcare intheinitial48hoursofadmission.Inthepre-interventionperiodpatients’carewaslargelyinconsistentwiththeguidelines,

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