ABSTRACT 73

Abstract

Background and aims: Home care for medically complex, technology assisted children is a challenge. Red Cross War Memorial Children’s Hospital (RCWMCH), a public sector institution in South Africa, has a home care program operating since 1989. There is a significant burden of poverty amongst the children we manage. Lack of access to community-based health care workers and resource-constraints are additional challenges. Aims: The aim of this study is to describe the outcomes and socio-economic indicators of children who went home with a tracheostomy between 2008 and 2012. Methods: Prospectively collected data from 2008 to 2012 were retrieved. The Medical Ethics Committee approved the data collection. Results: A total of 237 children with a median age of 14 months (interquartile range 3 to 48 months) obtained a tracheostomy between 2008 and 2012. Two-thirds of these children (n=157) went home despite their often poor socio-economic circumstances (see Figure). Indications for a tracheostomy were divided into upper airway obstruction (77%), long-term ventilation (11%), clearance of airway secretions (2%) or a combination of these in 9%.FigureConclusions: This innovative program proves that poor socioeconomic circumstances are not a barrier for tracheostomy home care. Success is achieved through individual training of primary caregivers in hospital which is tailored to the needs of the particular child’s home using simple technology and modified procedures.