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. 2023 Aug 31:63:102198.
doi: 10.1016/j.eclinm.2023.102198. eCollection 2023 Sep.

Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network

Chris A Rees  1   2 , Kitiezo Aggrey Igunza  3 , Zachary J Madewell  4 , Victor Akelo  5 , Dickens Onyango  6 , Shams El Arifeen  7 , Emily S Gurley  7   8 , Mohammad Zahid Hossain  7 , Afruna Rahman  7 , Muntasir Alam  7 , J Anthony G Scott  9 , Nega Assefa  9   10 , Lola Madrid  9 , Anteneh Belachew  10   11 , Haleluya Leulseged  10   11 , Karen L Kotloff  12 , Samba O Sow  13 , Milagritos D Tapia  12 , Adama Mamby Keita  13 , Diakaridia Sidibe  13 , Antonio Sitoe  14 , Rosauro Varo  14   15 , Sara Ajanovic  14   15 , Quique Bassat  14   15   16   17   18 , Inácio Mandomando  14   15   19 , Beth A Tippett Barr  20 , Ikechukwu Ogbuanu  21 , Carrie Jo Cain  22 , Ima-Abasi Bassey  21 , Ronita Luke  23 , Khadija Gassama  21 , Shabir Madhi  24 , Ziyaad Dangor  24 , Sana Mahtab  24 , Sithembiso Velaphi  25 , Jeanie du Toit  24 , Portia C Mutevedzi  26 , Dianna M Blau  4 , Robert F Breiman  27 , Cynthia G Whitney  26 ; Child Health and Mortality Prevention Surveillance Network
Collaborators, Affiliations

Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network

Chris A Rees et al. EClinicalMedicine. .

Abstract

Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children.

Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration.

Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h.

Interpretation: Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence.

Funding: Bill & Melinda Gates Foundation.

Keywords: Childhood; Clinical care; Guideline adherence; Mortality.

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Conflict of interest statement

CGW received honoraria from the University of St. Andrews for speaking to alumni about CHAMPS and global health work. JAGS reports receiving funding from the Wellcome Trust, UK FCDO, European Union, and the National Institute for Health Research. SM has received grants from the Bill & Melinda Gates Foundation, GSK, Pfizer, Minervax, Novavax, Providence, Gritstone, and ImmunityBio. SM has received honoraria from GSK for lecturing. CGW and SM report serving on data safety monitoring boards for SPEAC (CGW) and PATH and CAPRISA (SM). All other investigators declare no competing interests.

Figures

Fig. 1
Fig. 1
Adherence to WHO Pocket Book of Hospital Care for Children recommendations for lower respiratory infections determined by postmortem diagnosis (n = 249) A. All cases∗ B. Comparison of concordant vs. discordant antemortem and postmortem diagnoses and hospital admission duration∗∗ ∗Error bars represent 95% confidence intervals. ∗∗P values were calculated through chi-square test for each recommendation.
Fig. 2
Fig. 2
Adherence to WHO Pocket Book of Hospital Care for Children recommendations for sepsis determined by postmortem diagnosis (n = 226). A. All cases∗. B. Comparison of concordant vs. discordant antemortem and postmortem diagnoses and hospital admission duration∗∗. ∗Error bars represent 95% confidence intervals. ∗∗P values were calculated through chi-square test for each recommendation.
Fig. 3
Fig. 3
Adherence to WHO Pocket Book of Hospital Care for Children recommendations for severe acute malnutrition determined by postmortem diagnosis (n = 129). A. All cases∗. B. Comparison of concordant vs. discordant antemortem and postmortem diagnoses and hospital admission duration∗∗. ∗Error bars represent 95% confidence intervals. ∗∗P values were calculated through chi-square test for each recommendation.
Fig. 4
Fig. 4
Adherence to WHO Pocket Book of Hospital Care for Children recommendations for malaria determined by postmortem diagnosis (n = 107). A. All cases∗. B. Comparison of concordant vs. discordant antemortem and postmortem diagnoses and hospital admission duration∗∗. ∗Error bars represent 95% confidence intervals. ∗∗P values were calculated through chi-square test for each recommendation.
Fig. 5
Fig. 5
Adherence to WHO Pocket Book of Hospital Care for Children recommendations for diarrheal diseases determined by postmortem diagnosis (n = 80). A. All cases∗. B. Comparison of concordant vs. discordant antemortem and postmortem diagnoses and hospital admission duration∗∗. ∗Error bars represent 95% confidence intervals. ∗∗P values were calculated through chi-square test for each recommendation.
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