Hategeka Celestin, Shoveller Jean, Tuyisenge Lisine, Kenyon Cynthia, Cechetto David F, Lynd Larry D
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2017 Mar 3;12(3):e0173233. doi: 10.1371/journal.pone.0173233. eCollection 2017.
Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)-a locally adapted pediatric advanced life support management program-in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children.
A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children.
Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated.
Our assessment provides evidence to inform new strategies to enhance the capacity of Rwandan district hospitals to provide pediatric advanced life support management. Identifying key gaps in the health care system is required in order to facilitate the implementation and scale up of ETAT+ in Rwanda. These findings also highlight a need to establish an outreach/mentoring program, embedded within the ongoing ETAT+ program, to promote cross-hospital learning exchanges.
加强卫生系统对于改善资源匮乏国家的婴幼儿健康状况至关重要。尽管在过去几十年里，与提高新生儿和儿童存活率相关的知识有了显著进步，但在这些环境中的许多医疗系统仍然无法有效地提供儿科高级生命支持管理。随着卢旺达地区医院引入了因地制宜的儿科高级生命支持管理项目——紧急分诊、评估与治疗加入院护理（ETAT+），我们开展了这项研究，以评估这些医院在提供这种儿科高级生命支持管理方面的准备程度。该研究结果将揭示目前可用于实施ETAT+的资源和支持情况，ETAT+旨在改善对重症婴幼儿的护理。
在卢旺达的八家地区医院进行了一项横断面调查，重点关注提供对重症婴幼儿的紧急分诊、评估与治疗加入院护理所需的物力和人力资源以及医院服务组织情况。
许多被认为是为重症婴幼儿提供紧急护理所必需的基本资源都很容易获得（如药品和实验室服务）。然而，只有4/8的医院有新生儿用的袋阀面罩；2/8的医院没有雾化器和定量吸入器。只有3/8的医院有F-75和ReSoMal。此外，在所评估的任何一家医院中都没有适当的分诊系统。此外，分别有5/8和7/8的医院有新生儿复苏和疟疾管理指南；而儿童复苏以及败血症、肺炎、脱水和重度营养不良管理指南在不到一半的评估医院中存在。
我们的评估为制定新战略提供了依据，以提高卢旺达地区医院提供儿科高级生命支持管理的能力。需要找出卫生保健系统中的关键差距，以便在卢旺达促进ETAT+的实施和推广。这些发现还凸显了有必要在正在进行的ETAT+项目中建立一个外展/指导项目，以促进跨医院的学习交流。
