Division of Pediatric Critical Care, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Mbale Regional Referral Hospital, Busitema University Faculty of Health Sciences, Mbale, Uganda.
Malar J. 2024 Aug 15;23(1):245. doi: 10.1186/s12936-024-05076-w.
Malaria is the leading cause of hospitalizations and death in Uganda, particularly in children under the age of five. Studies have shown that adherence to the World Health Organization (WHO) guidelines for the management of severe malaria reduces mortality in hospitalized children. This study aimed to determine the impact of targeted interventions on adherence to the WHO severe malaria treatment guidelines in children at a Ugandan hospital as part of a quality improvement initiative.
Interventions included workflow changes, such as obtaining patient blood samples for diagnostic testing by the admitting healthcare provider as well as utilizing patient caregivers to assist nursing staff in timing medications. An additional intervention was the use of an admission checklist sticker. The post-intervention sample was compared to the baseline assessment. The primary outcome was the proportion of patients receiving care consistent with all aspects of the WHO guidelines. Secondary outcomes included the proportion of patients receiving malaria diagnostic testing, those receiving at least 3 doses of artesunate, the timely administration of artesunate, and adherence to other guideline components. Statistical analyses were conducted using GraphPad PRISM 9.0. Comparisons between groups were analysed using Chi-square or Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables.
The post-intervention group included 230 patients with a median age of 5 years [4-8], and 58% of patients were male. Adherence to all aspects of the WHO guidelines was achieved in 10% of patients in the post-intervention group compared to 3% of patients in the baseline (P = 0.007). Appropriate malaria diagnostic testing was performed in 85% of patients post-intervention compared to 66% of patients in the baseline (P < 0.0001). Patients in the post-intervention group were more likely to receive the minimum 3 doses of artesunate (86%) than in the baseline (74%) (P = 0.008). Patients in the post-intervention group were more likely to receive artesunate doses on time than in the baseline (dose 2 P = 0.02, dose 3 P = 0.003).
Targeted, low-cost interventions led to improvement in adherence to severe malaria treatment guidelines. The most notable changes were in malaria diagnostic testing and antimalarial administration.
疟疾是乌干达住院和死亡的主要原因，尤其是 5 岁以下儿童。研究表明，遵循世界卫生组织（WHO）严重疟疾管理指南可降低住院儿童的死亡率。本研究旨在确定针对乌干达一家医院儿童的靶向干预措施对 WHO 严重疟疾治疗指南的依从性的影响，这是一项质量改进计划的一部分。
干预措施包括工作流程的改变，例如让入院医疗服务提供者为患者采集血液样本进行诊断检测，以及利用患者护理人员协助护理人员按时给药。另一个干预措施是使用入院检查表贴纸。将干预后的样本与基线评估进行比较。主要结局是接受符合 WHO 指南所有方面的护理的患者比例。次要结局包括接受疟疾诊断检测的患者比例、接受至少 3 剂青蒿琥酯的患者比例、青蒿琥酯及时给药的比例以及遵守其他指南内容的比例。使用 GraphPad PRISM 9.0 进行统计分析。使用卡方检验或 Fisher 精确检验进行分类变量的组间比较，使用 Mann-Whitney 检验进行连续变量的组间比较。
干预后组包括 230 名中位年龄为 5 岁[4-8]的患者，其中 58%为男性。干预后组中 10%的患者符合 WHO 指南的所有方面，而基线组中 3%的患者符合（P=0.007）。干预后组中 85%的患者进行了适当的疟疾诊断检测，而基线组中 66%的患者进行了适当的疟疾诊断检测（P<0.0001）。干预后组患者更有可能接受至少 3 剂青蒿琥酯（86%），而基线组患者更有可能接受至少 3 剂青蒿琥酯（74%）（P=0.008）。与基线组相比，干预后组患者更有可能按时接受青蒿琥酯剂量（第 2 剂 P=0.02，第 3 剂 P=0.003）。
针对性的、低成本的干预措施提高了严重疟疾治疗指南的依从性。最显著的变化是在疟疾诊断检测和抗疟药物管理方面。
