Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-Resource Settings—A Two-Arm Interventional Feasibility Study

Abstract

IntroductionPediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. This study evaluates feasibility of implementation by caregivers and clinicians.MethodsRandomized controlled feasibility study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with caregivers at the bedside for 24 h were enrolled. Caregivers were trained using the FASTER tool. The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and standard care arms. Poisson regression with random intercept for grouping by patient was used, adjusting for admission pediatric early warning score, age, gender. Secondary outcomes included survey assessments of clinician and caregiver experiences with FASTER.ResultsOne hundred and fifty patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients' median age was 0.9 (range 0.2–10) and 1.1 years (range 0.2–12) in intervention vs. control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34 [24%]). 134 (96%) caregivers were patients' mothers. Clinician visits/hour increased with patients' illness severity in both arms, but without difference in frequency between arms (point estimate for difference −0.9%, p = 0.97). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33 (82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26 (65%) rating caregivers as able to adequately capture patients' severity of illness. Of 70 caregivers surveyed, 63 (90%) reported that FASTER training was easy to understand; all (100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community.DiscussionWe observed no difference in recorded frequency of clinician visits with FASTER monitoring. However, the tool was rated positively by caregivers and clinicians., Implementation appears feasible but requires optimization. These feasibility data may inform a larger trial powered to measure morbidity and mortality outcomes to determine the utility of FASTER in detecting and responding to clinical deterioration in low-resource settings.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT03513861.

The role of healthcare providers and caregivers in monitoring critically ill children: a qualitative study in a tertiary hospital, southern Malawi

“…A feasibility study conducted in Kenya suggested that empowering caregivers to assist with the timely recognition of deterioration in hospitalised children might expedite the clinical response and improve health outcomes [ 22 ]. With counselling and basic training from healthcare providers, caregivers could better monitor the progress of their hospitalised child, communicate more effectively and indicate concerns in a timely manner [ 22 ]. Supporting and training family members to participate in basic care in resource-limited hospitals could provide a safe and adequate opportunity to enhance care while tackling health provider shortages [ 23 ].…”

“…A feasibility study conducted in Kenya suggested that empowering caregivers to assist with the timely recognition of deterioration in hospitalised children might expedite the clinical response and improve health outcomes [22]. With counselling and basic training from healthcare providers, caregivers could better monitor the progress of their hospitalised child, communicate more effectively and indicate concerns in a timely manner [22].…”

The role of healthcare workers and caregivers in monitoring critically ill children: a qualitative study in Zomba, Malawi

“…Arnim et al have suggested that empowering caregivers to assist with the timely recognition of deterioration in hospitalised children might expedite the clinical response and improve health outcomes [22]. With counselling from healthcare workers, caregivers could better monitor the progress of their hospitalised child, communicate more effectively with healthcare providers and raise the alarm timeously [22].…”

“…Arnim et al have suggested that empowering caregivers to assist with the timely recognition of deterioration in hospitalised children might expedite the clinical response and improve health outcomes [22]. With counselling from healthcare workers, caregivers could better monitor the progress of their hospitalised child, communicate more effectively with healthcare providers and raise the alarm timeously [22]. Supporting and training family members to participate in basic care in resource-limited hospitals could provide a safe and adequate opportunity to enhance care while tackling health worker shortages [23].…”

Family involvement as a strategy to enhance patient care in low‐income country hospitals despite limited resources

“…3 The ability of parents to perform monitoring tasks, and their increased feelings of empowerment, is in line with studies from the Kenyatta National Hospital in Nairobi, Kenya, where the Family Assisted Severe Febrile Illness Therapy (FASTER) tool was developed, to allow caregivers of children admitted with a severe febrile illness to participate in monitoring of their children. 4,5 Caregivers' assessment of the child's illness severity matched with the assessment by healthcare personals in most cases. However, the study was not designed to assess the potential impact of the family-assisted intervention on the final hospital outcomes of admitted children.…”