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
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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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