Trawin Jessica, Knappett Martina, Komugisha Clare, Mwaka Savio, Bamwesigye Ezrah, Agaba Collins, Walugembe David, Nsungwa Sabiiti Jesca, Ansermino J Mark, Kissoon Niranjan, Kenya Mugisha Nathan, Wiens Matthew O
Institute for Global Health, British Columbia Children's Hospital and British Columbia Women's Hospital+Health Centre, Vancouver, Canada.
World Alliance for Lung and Intensive Care Medicine, Kampala, Uganda.
PLOS Glob Public Health. 2025 Aug 22;5(8):e0003559. doi: 10.1371/journal.pgph.0003559. eCollection 2025.
Under-five children in low- and middle-income countries remain at high risk of death after hospital discharge. However, few studies have systematically assessed discharge processes or facility readiness to support safe transitions of care. This study aimed to assess health facility readiness to provide pediatric discharge care for children under five years of age and current discharge practices in a nationally representative sample of health facilities in Uganda. A cross-sectional health facility scan was conducted between October 2020 and May 2021 at 36 facilities providing inpatient pediatric care in Uganda. Primary outcomes included: (1) facility readiness for pediatric discharge, defined as availability of infrastructure, technology, forms/job aids, and equipment; and (2) observed discharge care practices, including caregiver counselling, provision of take-home materials, post-discharge risk assessment, referrals, and clinical assessments on the day of discharge. Secondary outcomes included discrepancies between reported versus observed discharge care practices, discharge relevant admission practices, as well as caregiver and health worker satisfaction. Thiry-six health facilities were enrolled and 180 pediatric discharge observations, 180 caregivers, and 180 health workers were assessed. Hospitals had higher readiness scores in infrastructure (p < 0.001), technology (p = 0.006), and equipment (p = 0.021) than health centres. Hospitals also performed better in the provision of discharge risk assessment, clinical assessment on the day of discharge, follow-up, and provision of take-home materials. In contrast, health centres more consistently provided discharge counselling (p = 0.021) and had higher counselling topic scores (p < 0.001). Overall, 82.8% of discharges included a clinical assessment, 31.1% included a follow-up referral, and 26.1% included a risk assessment. Observed practices often diverged from reported procedures. These findings identified several priority areas for quality improvement in both resource availability and discharge care delivery in all settings. Standardizing discharge policies and tools may strengthen discharge care and may be used as a guide to inform national-level pediatric discharge policies.
低收入和中等收入国家的五岁以下儿童出院后仍面临着很高的死亡风险。然而，很少有研究系统地评估出院流程或医疗机构支持安全护理过渡的准备情况。本研究旨在评估乌干达全国具有代表性的医疗机构样本中，医疗机构为五岁以下儿童提供儿科出院护理的准备情况以及当前的出院实践。2020年10月至2021年5月期间，对乌干达36家提供儿科住院护理的医疗机构进行了横断面医疗机构扫描。主要结果包括：（1）儿科出院的机构准备情况，定义为基础设施、技术、表格/工作辅助工具和设备的可用性；（2）观察到的出院护理实践，包括对照顾者的咨询、提供带回家的材料、出院后风险评估、转诊以及出院当天的临床评估。次要结果包括报告的与观察到的出院护理实践之间的差异、与出院相关的入院实践，以及照顾者和卫生工作者的满意度。共纳入了36家医疗机构，评估了180例儿科出院观察情况、180名照顾者和180名卫生工作者。医院在基础设施（p < 0.001）、技术（p = 0.006）和设备（p = 0.021）方面的准备得分高于卫生中心。医院在提供出院风险评估、出院当天的临床评估、随访以及提供带回家的材料方面也表现更好。相比之下，卫生中心更持续地提供出院咨询（p = 0.021），且咨询主题得分更高（p < 0.001）。总体而言，82.8%的出院包括临床评估，31.1%包括随访转诊，26.1%包括风险评估。观察到的实践往往与报告的程序不一致。这些发现确定了所有环境下资源可用性和出院护理提供方面质量改进的几个优先领域。标准化出院政策和工具可能会加强出院护理，并可作为指导，为国家层面的儿科出院政策提供参考。
