Paediatric deaths in a tertiary government hospital setting, Malawi

Harris, Caroline; Mills, Rowena; Seager, Ezgi; Blackstock, Sarah; Hiwa, Tamanda; Pumphrey, James; Langton, Josephine

doi:10.1080/20469047.2018.1536873

Cited by 17 publications

(18 citation statements)

References 24 publications

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“…While our study showed great improvements in hospital readiness to manage severe malaria compared to previous ETAT evaluations in Malawi, [13] other deficiencies were found in these results. Specifically, least available items were nasogastric tubes, blood typing services, injectable hydrocortisone, micro nebulizers or spacer inhalers and radiology.…”

Section: Discussioncontrasting

confidence: 86%

“…The main causes of death in that hospital were malaria and malaria-related illnesses, pneumonia and malnutrition. A more recent study from a separate Malawi hospital found that nearly half (43%) of paediatric deaths were among infants, [13] and leading causes were sepsis, lower respiratory infections, gastroenteritis, meningitis and malaria.…”

Section: Introductionmentioning

confidence: 99%

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Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

et al. 2020

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Background: Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi's population distribution. Methods: We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results: Four (3.5, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4, 95% CI: 31.9-49.6), micro nebulizers (50.9, 95% CI: 41.9-60.0), and radiology (54.2, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67-77) ranging 1-507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%, p < 0.001).

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Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

Johansson

Lindsjö

Weiss

et al. 2019

Preprint

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Background Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi’s population distribution. Methods We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results Four (3.5%, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4%, 95% CI: 31.9-49.6), micro nebulizers (50.9%, 95% CI: 41.9-60.0), and radiology (54.2%, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 minutes (95% CI: 67-77) ranging 1-507 minutes. Approximately one-quarter (27%) of Malawians lived over 120 minutes from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38% and 35%, p<0.001). Conclusions There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.

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“…(12) The main causes of death in that hospital were malaria and malaria-related illnesses, pneumonia and malnutrition. A more recent study from a separate Malawi hospital found that nearly half (43%) of paediatric deaths were among infants, (13) and leading causes were sepsis, lower respiratory infections, gastroenteritis, meningitis and malaria. Some governments, including Kenya and Malawi, have recently updated ETAT guidelines to provide more detailed instructions on equipment and processes needed for implementation.…”

Section: Introductionmentioning

confidence: 99%

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

Johansson

Lindsjö

Weiss

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Emergency care is among the weakest parts of health systems in low-income countries. Previous studies estimated accessibility to emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and relative to Malawi’s population distribution. Methods We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results Four (3.5%, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4%, 95% CI: 31.9-49.6), micro nebulizers (50.9%, 95% CI: 41.9-60.0), and radiology (54.2%, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 minutes (95% CI: 67-77) ranging 1-507 minutes. Approximately one-quarter (27%) of Malawians lived over 120 minutes from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38% and 35%, p<0.001). Conclusions There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.

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Paediatric deaths in a tertiary government hospital setting, Malawi

Cited by 17 publications

References 24 publications

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

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