Department of Global Health, University of Washington School of Public Health, Seattle, Washington, United States of America.
Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America.
PLoS One. 2021 Apr 23;16(4):e0249569. doi: 10.1371/journal.pone.0249569. eCollection 2021.
To assess attitudes, perceptions, and practices of healthcare workers regarding hospital discharge and follow-up care for children under age five in Migori and Homa Bay, Kenya.
This mixed-methods study included surveys and semi-structured telephone interviews with healthcare workers delivering inpatient pediatric care at eight hospitals between November 2017 and December 2018.
The survey was completed by 111 (85%) eligible HCWs. Ninety-seven of the surveyed HCWs were invited for interviews and 39 (40%) participated. Discharge tasks were reported to be "very important" to patient outcomes by over 80% of respondents, but only 37 (33%) perceived their hospital to deliver this care "very well" and 23 (21%) believed their facility provides sufficient resources for its provision. The vast majority (97%) of participants underestimated the risk of pediatric post-discharge mortality. Inadequate training, understaffing, stock-outs of take-home therapeutics, and user fees were commonly reported health systems barriers to adequate discharge care while poverty was seen as limiting caregiver adherence to discharge and follow-up care. Respondents endorsed the importance of follow-up care, but reported supportive mechanisms to be lacking. They requested enhanced guidelines on discharge and follow-up care.
Kenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality. Pre- and in-service training should incorporate instruction on discharge and follow-up care. Improved post-discharge deaths tracking-e.g., through vital registry systems, child mortality surveillance studies, and community health worker feedback loops-is needed, alongside dissemination which could leverage platforms such as routine hospital-based mortality reports. Finally, further interventional trials are needed to assess the efficacy and cost-effectiveness of novel packages to improve discharge and follow-up care.
评估肯尼亚米戈里和霍马湾的医疗保健工作者对五岁以下儿童出院和后续护理的态度、看法和做法。
本混合方法研究包括对 2017 年 11 月至 2018 年 12 月期间在 8 家医院提供住院儿科护理的医疗保健工作者进行调查和半结构化电话访谈。
调查完成后，有 111 名（85%）符合条件的 HCWs 参与了调查。对参与调查的 97 名 HCWs 发出了访谈邀请，其中 39 名（40%）人参与了访谈。超过 80%的受访者认为出院任务对患者的结果“非常重要”，但只有 37 名（33%）人认为他们的医院提供了“非常好”的护理，23 名（21%）人认为他们的医院提供了足够的资源来提供这种护理。绝大多数（97%）的参与者低估了儿科出院后死亡的风险。受访者报告称，培训不足、人手不足、出院治疗药物缺货和医疗费用是阻碍提供充分出院护理的常见卫生系统障碍，而贫困则被认为限制了照顾者对出院和随访护理的依从性。受访者认为后续护理很重要，但报告称缺乏支持机制。他们要求提供更多关于出院和后续护理的指导方针。
肯尼亚医疗保健工作者严重低估了儿科出院后死亡的风险。应将预出院和在职培训纳入出院和后续护理的内容。需要改善出院后死亡的跟踪，例如通过人口登记系统、儿童死亡率监测研究和社区卫生工作者反馈循环，并通过常规医院死亡率报告等平台传播，以利用这些信息。最后，需要进一步的干预性试验来评估提高出院和后续护理的新型护理包的疗效和成本效益。
