Ngabireyimana Eric, Mutaganzwa Christine, Kirk Catherine M, Miller Ann C, Wilson Kim, Dushimimana Evodia, Bigirumwami Olivier, Mukakabano Evelyne S, Nkikabahizi Fulgence, Magge Hema
Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda.
Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
Matern Health Neonatol Perinatol. 2017 Jul 12;3:13. doi: 10.1186/s40748-017-0052-2. eCollection 2017.
As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda.
At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014-December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher's Exact test and -values calculated using trend analysis.
426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age ( = 0.003), interval growth, danger sign assessment, and feeding difficulties ( < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time ( < 0.001).
It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.
随着越来越多的高危新生儿度过新生儿期,他们仍面临重大的医疗、营养和发育风险。然而,大多数发展中国家没有早期干预的随访系统。2014年,卢旺达农村地区的一家区级医院及周边健康中心实施了一项新型儿科发育诊所(PDC),由护士和社会工作者主导,为五岁以下高危儿童提供全面随访。
在每次PDC就诊时,儿童接受临床/营养评估,护理人员参加咨询会议。社会评估确定需要额外社会支持的家庭。使用年龄与发育进程问卷完成发育评估。对2014年4月至2015年12月在卢旺达农村地区登记的患者进行了回顾性病历审查,以评估PDC实施的前24个月情况。使用频率和比例描述患者及其护理人员的人口统计学和临床特征。使用Fisher精确检验对PDC就诊不同核心组成部分的完成情况进行长期比较,并使用趋势分析计算P值。
5个PDC站点共登记了426名患者。54%为女性,44%为新生儿,35%在登记时年龄小于6个月。最常见的转诊原因是早产/低出生体重(63%)和缺氧缺血性脑病(34%)。在24个月内,共进行了2787次PDC就诊。护士在每次就诊时均能持续完成人体测量(年龄、体重、身高)。一些就诊组成部分记录不一致,包括矫正年龄(P = 0.003)、间隔期生长、危险体征评估和喂养困难(P < 0.001)。其他就诊组成部分,如儿童发育咨询和游戏/刺激活动的完成率较低,但随时间有所改善(P < 0.001)。
在农村地区由非专业人员实施PDC是可行的,因为我们能够招募到不同类型的高危婴儿。随着时间的推移,我们看到PDC提供的服务有所改善,目前正在持续进行质量改进努力以弥补现有差距。目前正在开展未来研究,观察受益于PDC项目的儿童的结局。