Puoane Thandi, Sanders David, Ashworth Ann, Chopra Mickey, Strasser Susan, McCoy David
School of Public Health, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa.
Int J Qual Health Care. 2004 Feb;16(1):31-40. doi: 10.1093/intqhc/mzh002.
To improve the clinical management of severely malnourished children in rural hospitals in South Africa.
A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research.
Two rural first-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province.
A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care.
Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by approximately 25% in both hospitals.
Participatory research led to the formation of a hospital nutrition team, which identified shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates.
改善南非农村医院中重度营养不良儿童的临床管理。
一项分三个阶段的干预前后描述性研究：评估重度营养不良儿童的临床管理情况，制定并实施一项提高护理质量的行动计划，以及监测和评估目标活动。采用参与式方法让地区和医院营养团队参与研究的各个阶段。
东开普省弗勒里山地区的两家农村一级转诊医院（玛丽·特里萨医院和西佩图医院）。
对所有重度营养不良住院病例进行回顾性记录审查，以获取患者特征和病死率；对随机抽取的病例进行详细审查，以说明一般病例管理情况；在儿科病房进行结构化观察，以评估照顾营养不良儿童的资源充足程度；与护理和医务人员进行深入访谈及焦点小组讨论，以确定提高护理质量的障碍。
研究前，玛丽·特里萨医院和西佩图医院的病死率分别为50%和28%。来自案例研究、观察、访谈和焦点小组讨论的信息揭示了知识、资源和实践方面的许多不足。医院营养团队制定并实施了一项提高护理质量的行动计划，并开发了监测其实施情况和评估其影响的工具。在实施后的12个月内，两家医院的病死率均下降了约25%。
参与式研究促成了医院营养团队的形成，该团队发现了重度营养不良儿童临床管理中的缺陷，并采取行动提高护理质量。这些行动与病死率的降低相关。
