Studies in low income countries have repeatedly shown that health workers barely comply with global, evidence-based clinical guidelines when managing common but serious childhood diseases, a new study has found.
However, researchers from KEMRI-Welcome Trust, who conducted the study, found that the active dissemination of paediatric clinical guidelines can greatly improve the quality of care and service received by seriously sick children in Kenya.
The results, which were published in PLOS ONE last week, propose that more attention must be given to broader implementation strategies that target institutional and organizational aspects of service delivery to further enhance quality‐of‐care.
The study, which was carried out at the Kenyatta National Hospital, set out to evaluate the impact of purposefully and widely disseminating clinical management guidelines to targeted clinical and nursing care providers in general paediatric wards. Emergency triage assessment and treatment plus admission care training (ETAT+), which focuses on care in the first 24 to 48 hours of admission, was also provided to paediatric health care staff as part of the study.
For the study researchers focused on the three common childhood diseases of pneumonia, dehydration (due to diarrhoea) and severe malnutrition. These three diseases have a high disease burden and high levels of mortality. Furthermore, World Health Organisation/ Kenyan case management guidelines for medical staff on all three diseases have remained the same for the last twelve years.
Commenting on the results, Dr Grace Irimu, the study’s lead author, said: “Our study found that active efforts to change practice that build on the distribution of guidelines and provision of training, and that engage multiple health workers, can significantly improve the uptake of nationally and internationally recommended practices.
“We also observed a fall in mortality over the same time period. However, this could be due to a number of other factors that our study could not account for. Taken with other studies, there is reason to expect that the adherence to simple and low‐cost recommendations, as stipulated in national and WHO case management guidelines, combined with other improvements in service provision, may reduce case fatality of common serious illnesses.”
Also commenting on these results, co-author Prof Mike English, said: “The slow pace of getting evidence into routine healthcare practice is a global concern. This work illustrates that it can be done but also indicates that we have to do more than simply printing guidelines or running training courses, we need to actively promote new practices, work with hospitals and sustain efforts.”
Health workers’ compliance to evidence based Clinical Management guidelines including ETAT+ is an important part of ensuring the timely, appropriate and safe hospital care of seriously ill children. This study emphasized the need for more deliberate and targeted dissemination of these guidelines to paediatric health workers even in large teaching hospitals in low income countries such as Kenya. If health workers learn how to use guidelines during their training in major hospitals, they should be better able to support efforts to reduce childhood mortality and ultimately help in meeting the fourth millennium development goal.