A pediatric death audit in a large referral hospital in Malawi

Fitzgerald, Elizabeth; Mlotha-Mitole, Rachel; Ciccone, Emily J.; Tilly, Alyssa; Montijo, Jennie M.; Lang, Hans-Joerg; Eckerle, Michelle

doi:10.1186/s12887-018-1051-9

Cited by 26 publications

(36 citation statements)

References 29 publications

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“…Hence these patients are different from patients with other deadly infectious diseases, e.g. malaria, cholera, leishmaniasis, where patients have no other choice but to report early and follow medical instructions [ 50 , 51 ]. Moreover, mycetoma patients with early lesions differ from patients with large disabling mycetoma lesions.…”

Section: Discussionmentioning

confidence: 99%

A holistic approach to the mycetoma management

et al. 2018

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Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.

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Section: Discussionmentioning

confidence: 99%

A holistic approach to the mycetoma management

et al. 2018

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“…Even in an era of ‘big-data’ 27 28 learning the lessons from detailed analysis of individual cases has an important value. 7 WHO held a meeting on Child Death Review in Geneva in November 2016, and this study was an attempt to pilot the tools developed and evaluate the process.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the process and outcomes of child death review in the Solomon Islands

Sandakabatu¹,

Nasi²,

Titiulu³

et al. 2018

Arch Dis Child

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While maternal and perinatal mortality auditing has been strongly promoted by the World Health Organization (WHO), there has been very limited promotion or evaluation of child death auditing in low/middle-income settings. In 2017, a standardised child death review process was introduced in the paediatric department of the National Hospital in Honiara, Solomon Islands. We evaluated the process and outcomes of child death reviews. The child death auditing process was assessed through systematic observations made at each of the weekly meetings using the following standards for evaluation: (1) adapted WHO tools for paediatric auditing; (2) the five stages of the audit cycle; (3) published principles of paediatric audit; and (4) WHO and Solomon Islands national clinical standards of Hospital Care for Children. Thirty-three child death review meetings were conducted over 6 months, reviewing 66 neonatal and child deaths. Some areas of the process were satisfactory and other areas were identified for improvement. The latter included use of a more systematic classification of causes of death, inclusion of social risk factors and community problems in the modifiable factors and more follow-up with implementation of action plans. Areas for improvement were in communication, clinical assessment and treatment, availability of laboratory tests, antenatal clinic attendance and equipment for high dependency neonatal and paediatric care. Many of the changes recommended by audit require a quality improvement team to implement. Child death auditing can be done in resource-limited settings and yield useful information of gaps which are linked to preventable deaths; however, using the data to produce meaningful changes in practice is the greatest challenge. Audit is an iterative and evolving process that needs a structure, tools, evaluation, and needs to be embedded in the culture of a hospital as part of overall quality improvement, and requires a quality improvement team to follow-up and implement action plans.

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“…A rudimentary root cause analysis for each death was postulated, and subsequent recommendations were made. It was observed informally by the researcher-in-residence (CC) that the quality of the paper records is very poor [ 12 ], with faded, illegible writing, and the death audit process is time-consuming and often takes a whole day. She also observed that clinicians find it particularly difficult to attend death audits as their clinical duties continue.…”

Section: Methodsmentioning

confidence: 99%

“…Despite being one of the least developed countries in the world, Malawi has seen great success in achieving the Millennium Development Goal 4 [ 11 ], particularly for underfive mortality; however, for newborns, mortality is persistently high. A previous pediatric death audit in Kamuzu Central Hospital (KCH), a large referral center in Malawi, was recently published and cited reliable records as a significant limitation, with 6% of charts missing and documentation deficiencies in 58% of the charts reviewed [ 12 ]. To our knowledge, a perinatal death audit has not yet been published from Malawi or other sub-Saharan countries.…”

Section: Introductionmentioning

confidence: 99%

Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit

Crehan

Kesler

Chikomoni³

et al. 2020

JMIR Mhealth Uhealth

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Background Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. Objective This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. Methods Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. Results Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. Conclusions This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings.

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A pediatric death audit in a large referral hospital in Malawi

Cited by 26 publications

References 29 publications

A holistic approach to the mycetoma management

A holistic approach to the mycetoma management

Evaluating the process and outcomes of child death review in the Solomon Islands

Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit

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