‘We just dilute sugar and give’ health workers’ reports of management of paediatric hypoglycaemia in a referral hospital in Malawi

Abstract

Background: Acutely sick children in resource-constrained settings who present with hypoglycaemia have poor outcomes. Studies have questioned the current hypoglycaemia treatment cut-off level of 2.5 mmol/l. Improved knowledge about health workers’ attitudes towards and management of hypoglycaemia is needed to understand the potential effects of a raised cut-off level. Objective: This research explored health workers’ perceptions about managing acutely ill children with hypoglycaemia in a Malawian referral hospital. A secondary objective was to explore health workers’ opinions about a potential increase in the hypoglycaemia cut-off level. Methods: We used a qualitative design with semi-structured individual interviews performed with health workers in the Paediatric Accident and Emergency Unit at Queen Elizabeth Central Hospital, Malawi, in October 2016. Data were analysed using latent content analysis. Ethical approval was obtained from the University of Malawi, College of Medicine Research and Ethics Committee P.01/16/1852. Results: Four themes were formed that described the responses. The first, ‘Critical and difficult cases need easy treatment’, showed that health workers perceived hypoglycaemia as a severe condition that was easily manageable. The second, ‘Health system issues’, revealed challenges relating to staffing and resource availability. The third, ‘From parental reluctance to demand’, described a change in parents’ attitudes regarding intravenous treatments. The fourth, ‘Positive about the change but need more information’, exposed health workers’ concerns about potential risks of a raised cut-off level for hypoglycaemia treatment, as well as benefits for the patients. Conclusions: Health workers perceived hypoglycaemia as a severe condition that is easy to manage when the required equipment and supplies are available. Due to the common lack of test equipment and dextrose supplies, health workers have adopted alternative strategies to diagnose and manage hypoglycaemia. A change to the hypoglycaemia treatment cut-off level raised concerns about potential risks, but was also thought to be of benefit for some patients.

Paediatric Emergency Triage, Assessment and Treatment (ETAT) – preparedness for implementation at primary care facilities in Malawi

“…Given the difficulty of urgent referral, it was apparent that many HCWs attempt to stabilise patients within frontline facilities. Several adaptations to lacking resources were discussed, and reflects similar challenges in treating emergency cases reported from a hospital setting in Malawi [ 27 ]. Indeed, the lack of equipment and drugs to treat emergency cases has been reported in referral centres, which should be implementing ETAT [ 28 ].…”

Feeding practices and association of fasting and low or hypo glycaemia in severe paediatric illnesses in Malawi – a mixed method study

“…While plausible that fasting and the associated low blood glucose levels are simply markers of disease severity as intake commonly declines with increased illness severity [24,25] we found no association of WHO emergency signs with low glycaemia and a weak association between WHO emergency signs and hypo glycaemia. Indeed, the presence of fasting in a sick child was already used by health workers as a proxy for hypoglycaemia in the absence of diagnostic testing in a study on current management of paediatric hypoglycaemia among Malawian health workers [26].…”

The introduction of a paediatric nutrition support program led by a clinical dietitian at a low-resource hospital setting in Malawi

“…QECH is a tertiary care center that acts as the main teaching hospital for the University of Malawi College of Medicine. Within the Department of Paediatrics at QECH, approximately 26000 children are treated as inpatients each year with a mortality rate of around 5% [20,21]. Paediatric patients are triaged at the paediatric emergency department and can then be admitted to the paediatric intensive care unit (PICU), surgical ward, special care ward, nutritional rehabilitation unit (NRU), medical bay, oncology ward, or nursery.…”