Management Of Illness In Children Research Articles

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care.

Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care. The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care. A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital's laboratory register for the period 2013-2014 and clinical in-ward observations at a tertiary children's referral hospital in Sweden, the Astrid Lindgren Children's Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure. The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%). PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

Antibiotic use in Moshi Urban: A cross-sectional Study of Knowledge and Practices among Caretakers of Children in Kilimanjaro Tanzania

IntroductionAntibiotics are commonly accessed and used for the management of illness in children without a prescription. We investigated the caretaker’s knowledge and practices on antibiotics and antibiotics use to their children.MethodThis was the hospital-based cross-sectional study conducted from April to July 2017 in three facilities located in Moshi Municipality. A convenience sampling was employed to select for caretakers with their sick children at KCMC, Mawenzi hospital, and Longuo dispensary. Face-to-face interviews were conducted with 224 caretakers who had visited health facilities with their children seeking health care.ResultsThe majority (87.9%, 197/224) of all interviewed caretakers had good knowledge of the use of antibiotics. Irrespective of knowing that it is not safe to self-medicate a child with any antibiotics (95.1%, 213/224), most (61.6%, 138/224) caretakers practiced self-medication with the medicines. Having two children (aOR = 7.75, 95% CI: 1.89-31.67) and having three children (aOR=7.23, 95%CI: 1.08-48.51) were significantly associated with good knowledge of antibiotics.ConclusionThis study has revealed that caretakers in Moshi had a good knowledge of antibiotic use. However, despite such good knowledge, malpractices were observed. We call upon the use of media campaigns to advocate for the importance of the rational use of antibiotics and its effect on human health and the risk of antimicrobial resistance development.Rwanda J Med Health Sci 2021;4(3):347-356

CADRES COMPETENCE IN COMMUNITY-BASED MANAGEMENT OF CHILD ILLNESS IN BANYUMAS DISTRICT, CENTRAL JAVA, INDONESIA

Background: One of the efforts in the health sector for programs to reduce infant and under-five mortality and morbidity rates is by the competence-based integrated management childhood illness (CB-IMCI) program. However, the program has been poorly implemented by health workers at the health center. Thus, the involvement of cadres is needed and their competency remains important to be improved.
 Objective: To quantitatively analyze cadre knowledge and competencies in the CB-IMCI program, and its relationship with the implementation of CB-IMCI, as well as to qualitatively explore and analyze the responses of cadres, health workers, and the community to the addition of cadre roles to the management of sick children.
 Methods: This was a mixed methods study with randomized controlled trials and qualitative method. For randomized controlled trials, 100 cadres were selected, which 50 randomly assigned in the intervention and control group. And for quantitative methods, informants included 10 cadres, 4 health workers, and 20 mothers. Paired t-test and independent t-test were employed for quantitative analysis, and triangulation was used for qualitative analysis.
 Results: The improvement of knowledge in the intervention group was better (I=14.42/C=4.44/p-value 0.00). The intervention group was more competent in the management of child illness (p-value 0.00). In addition, the cadres have additional competencies assisted by health workers to confidently detect cases earlier, and health center services reach a wider coverage in the community.
 Conclusion: The addition of cadres’ roles and competencies in the management of child illness in the community can be implemented in Banyumas District. It is suggested that the implementation of this program should be followed up in other health centers by the Health Department of Indonesia.

Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (\u226412\xa0years) in Kampala city, Uganda

BackgroundMedicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city.MethodsThis was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection.ResultsThe prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68).ConclusionChildren are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.

Audit of care of severely malnourished children aged 6-59 months at Al-Sabah Children Hospital, Juba, South Sudan.

Introduction : Diarrhoea is a leading cause of mortality and morbidity in children under five worldwide and accounts for 42.9% of under-5 mortality in South Sudan. Clinical outcomes for diarrhoea correlate with the quality of hospital care. Methodology : The standard WHO/IMCI for assessment of health workers’ performance in the management of illnesses in children under 5years was adapted and used in the study. Questionnaires and interviews were used to collect data on health workers’ knowledge and practice in the management of acute diarrhoea. Descriptive analysis was used to determine the means, frequencies and proportions of the variables. Results : Thirty nine health workers were interviewed and 202 medical records of children admitted with acute diarrhoea between March and June 2014 were examined. The majority (75.74%) of the children were 6-24 months old. Most assessments were incomplete; the commonest sign assessed was sunken eyes (75.12%) and the least assessed was ability to drink/breastfeed (34.32%). Seventy five percent of patients were classified correctly according to WHO guidelines and 61% of health workers administered fluid therapy correctly. Health workers’ knowledge of how to assess the hydration state was poor (below 50%). Conclusion : There was inadequate assessment and documentation of the signs and symptoms of dehydration and inappropriate use of rehydration fluid therapy in the children admitted with acute watery diarrhoea. Regular in-house training and feedback and provision of supplies should be given to the clinicians in order to improve the quality of care. Key words: acute diarrhoea, assessment, South Sudan

Assessment of parental knowledge of the management of acute illness in children on long-term steroids

Assessment of parental knowledge of the management of acute illness in children on long-term steroids

Respiratory emergencies and airway management in children

Respiratory emergencies in children are frequent and are caused by the specific airway anatomy and the susceptibility for infections.This article reviews the specific approach to pediatric airway management. According to the ABC guidelines of the European Resuscitation Council, the described algorithm should help to identify, classify, and treat such emergencies, giving those with less pediatric experience a tool for the management of respiratory illness in children. Focus is on the emergency care of the most common diseases in this age group.

Beyond Malaria — Causes of Fever in Outpatient Tanzanian Children

BackgroundAs the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children.MethodsWe recruited children younger than 10 years of age with a temperature of 38°C or higher at two outpatient clinics — one rural and one urban — in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria.ResultsAnalyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease.ConclusionsThese results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. (Funded by the Swiss National Science Foundation and others.)

Management of Febrile Illness in children less than 5 years of age at Limbe Health Center, Blantyre District in Malawi: a best practice implementation project

Background In Malawi, malaria, pneumonia and diarrhoea are leading causes of death in children < 5. Fever is a core symptom for each of these diseases. It is critical for child health that febrile illness management is best practice. Objectives This project aimed to assess current and promote evidence based best practice pediatric febrile management and thereby improve child health outcomes in Limbe Health Centre Malawi. Methods The project used the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice. A baseline audit was conducted followed by implementation of an education strategy targeted at clinicians to improve practice and follow-up audit. Results At baseline there was no compliance in taking temperature at triage and administration of antipyretics as clinically indicated. There was low compliance (45%) in providing full assessment of a sick child and in the number of parents and carers given information on home management. Follow up audit produced better outcomes. 90% of the children had temperature taken at triage, 90% were fully assessed, 100% received antipyretics as clinically indicated and 100% of caregivers received information on home management. Conclusion This evidence implementation project provides another example of how evidence based audit and feedback may be used to improve practice and health outcomes, even in a low resource setting. To ensure that the shift towards evidence based practice in management of febrile illness in children is maintained further audits and feedback cycles will be needed.

Clinical outcome at 2 years following diagnosis of medium chain acyl coenzyme a dehydrogenase deficiency through newborn screening: findings from the prospective UK collaborative and british paediatric surveillance unit studies

Background Newborn screening for medium chain acyl coenzyme A dehydrogenase deficiency (MCADD) has been implemented in a number of countries, including England (April 2009) but there are few reports of clinical outcome in large-scale prospective studies. During a UK pilot screening phase, all screen positive babies were followed through the British Paediatric Surveillance Unit (BPSU) to ascertain clinical outcome. Aim To report the spectrum of screen-positive MCADD referrals over a 2-year period and clinical outcomes at 2 years following confirmed MCADD diagnosis. Methods Between 1 March 2004 and 28 February 2006, 102 children were referred as presumptive positive (average triplicate screening C8 ≥0.5μmol/L) among 738 242 newborns screened at age 5–8 days (screen positive prevalence 1.4 per 10 000). Blood acylcarnitines, urine organic acids and c.985→G status, with extended mutation analysis in all non-c.985→G homozygotes (HMZ), were measured in all cases. Results were reviewed using an agreed diagnostic algorithm by an independent expert panel who assigned children to one of four categories: MCADD of definite phenotype; MCADD of uncertain phenotype; carriers; not MCADD. Clinician-reported clinical outcome at 1 and 2 years was obtained by systematic follow-up of new diagnoses notified to the BPSU. Results Of 102 screen positive infants (12 Asian; 43 female), 86 were confirmed as MCADD (positive predictive value 84%): 60 of definite phenotype (47 c.985→G HMZ, 13 other genotypes of known pathogenicity); 26 of uncertain phenotype (all with genotypes of uncertain pathogenicity). 79/86 (92%) were notified to the BPSU, with complete follow-up in 76 and partial follow up in three. At 2 years, one serious clinical episode was reported, one child experienced apnoea following vaccination and one child was reported with developmental delay/poor growth. One child (c.985→G HMZ) died after the 2-year follow-up period (age 2 years 9 months) during an intercurrent illness. Conclusion The specificity of screening is high and prevalence of c.985A→G homozygosity (55%) is comparable to other international screening programmes. While clinical outcome among screened babies appears good, death can occur highlighting the importance of timely management of acute illnesses in children with MCADD and effective information for and education of parents. Further information on longer-term outcomes is needed.

President's messageIn support of the pediatric health care home

President's messageIn support of the pediatric health care home