Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial
Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial
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DOI：
10.1136/bmj.39345.467813.80
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发表时间：
2007-10-27
影响因子：
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通讯作者：
Aaby, Peter
中科院分区：
文献类型：
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作者：
Biai, Sidu;Rodrigues, Amabelia;Aaby, Peter
目的测试是否严格执行疟疾管理的标准化协议，并为卫生工作者提供经济激励，降低mortality.Design Randomised Controlled Intervention Trial.Setting在几内亚比绍国立医院儿科病房。所有因严重疟疾入院的儿童都获得了免费的药物包。参与者951名3个月至5岁的儿童因疟疾诊断而入院，随机分配到正常病房或干预病房。在研究开始之前，所有人员都接受了使用疟疾管理标准化指南的培训，包括严格的随访程序。护士和医生被随机分配到干预病房或对照病房工作。干预病房的工作人员得到了一小笔经济奖励（五十元;二十五元;结果干预组和对照组的住院死亡率分别为5%和10（风险比0.48，95%置信区间0.29至0.79）。在疟疾玻片阳性的患者中，这种效应可能更强（0.36，0.16至0.80）。出院后4周的累积死亡率也较低的干预组（0.61，0.40至0.95）。结论监督医护人员坚持标准化的治疗方案，大大降低了住院死亡率。财政奖励对于工作人员的奉献和遵守规定可能很重要。
Objective To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality.Design Randomised controlled intervention trial.Setting Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits.Participants 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. Interventions Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50; 25; pound (sic)35/month) and their compliance with standard case management was closely monitored.Main outcome measures In-hospital mortality and cumulative mortality within 4 weeks of hospital admission.Results In-hospital mortality was 5% for the intervention group and 10% in the control group (risk ratio 0.48, 95% confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95).Conclusions Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospitat mortality. Financial incentives may be important for the dedication and compliance of staff members.