Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study
Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study
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DOI：
10.1371/journal.pone.0197607
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发表时间：
2018-05-17
期刊：
影响因子：
3.7
通讯作者：
English, Mike
中科院分区：
文献类型：
--
作者：
Gachau, Susan;Irimu, Grace;English, Mike
严重急性营养不良（SAM）是世界范围内5岁以下儿童入院和住院死亡的主要原因。在这项研究中，我们探讨了SAM的患病率和结果在13个肯尼亚医院参加临床信息网络（CIN）的儿童入院。我们还描述了他们立即住院management.MethodsWe分析了数据为1 - 59个月的儿童出院后的医疗记录回顾性收集。使用平均值、中位数和范围总结与SAM相关的汇总和年龄特异性患病率和死亡率。评估了关键体征和症状（S/S）的记录以及世卫组织管理步骤选定方面的护理质量指标的表现。Logistic回归模型用于评估6 - 59个月SAM患者中记录的S/S和死亡率之间的相关性。结果2013年12月至2016年11月，在CIN医院住院的54140名1-59个月儿童中，有5306名（9.8%）患有SAM。临床医生确定的SAM患病率和病死率在各医院之间差异很大，中位比例（范围）分别为10.1%（4.6 - 18.2%）和14.8%（6.0 - 28.6%）。17个变量与死亡率增加相关。随着时间的推移，管理步骤的性能变化各不相同的医院，并在选定的指标，但建议一些影响定期审计和feedbacks.ConclusionIdentification SAM患者，他们的死亡率和坚持住院病人的管理建议各不相同的医院。一组重要的SAM患者年龄小于6个月。需要继续努力，以改善管理SAM在常规设置的努力，以减少住院死亡率的一部分。
BackgroundSevere acute malnutrition (SAM) remains a major cause of admission and inpatient mortality worldwide in children aged less than 5 years. In this study, we explored SAM prevalence and outcomes in children admitted in 13 Kenyan hospitals participating in a Clinical Information Network (CIN). We also describe their immediate in-patient management.MethodsWe analyzed data for children aged 1-59 months collected retrospectively from medical records after discharge. Mean, median and ranges were used to summarize pooled and age specific prevalence and mortality associated with SAM. Documentation of key signs and symptoms (S/S) and performance of indicators of quality of care for selected aspects of the WHO management steps were assessed. Logistic regression models were used to evaluate associations between documented S/S and mortality among SAM patients aged 6-59 months. Loess curves were used to explore performance change over time for indicators of selected SAM management steps.Results5306/54140 (9.8%) children aged 1-59 months admitted with medical conditions in CIN hospitals between December 2013 and November 2016 had SAM. SAM prevalence identified by clinicians and case fatality varied widely across hospitals with median proportion (range) of 10.1% (4.6-18.2%) and 14.8% (6.0-28.6%) respectively. Seventeen variables were associated with increased mortality. Performance change over time of management steps varied across hospitals and across selected indicators but suggests some effect of regular audit and feedback.ConclusionIdentification of SAM patients, their mortality and adherence to in-patient management recommendations varied across hospitals. An important group of SAM patients are aged less than 6 months. Continued efforts are required to improve management of SAM in routine settings as part of efforts to reduce inpatient mortality.