Decreased pediatric hospital mortality after an intervention to improve emergency care in Lilongwe, Malawi.
OBJECTIVE
Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in the developing world. This deficiency contributes to high inpatient mortality rates, particularly early during hospitalization. Our referral hospital in Lilongwe, Malawi, experiences high volume, acuity, and mortality rates. The entry point to our hospital for most children presenting with acute illness is the Under-5 Clinic. We hypothesized that early inpatient mortality and total inpatient mortality rates would decrease with an intervention to prioritize and improve pediatric emergency care at our hospital.


METHODS
We implemented the following changes as part of our intervention: (1) reallocation of senior-level clinical support from other areas of the hospital to the Under-5 Clinic for supervision of emergency care, (2) institution of a formal triage process that improved patient flow, and (3) treatment and stabilization of patients before transfer to the inpatient ward. We compared early inpatient and total inpatient mortality rates before and after the intervention.


RESULTS
After the intervention, early mortality decreased from 47.6 to 37.9 deaths per 1000 admissions (relative risk 0.80, 95% confidence interval 0.67-0.93). Total mortality also decreased from 80.5 to 70.5 deaths per 1000 admissions after the intervention (relative risk 0.88, 95% confidence interval 0.78-0.98).


CONCLUSIONS
Simple, inexpensive interventions to improve pediatric emergency care at this underresourced hospital in sub-Saharan Africa were associated with decreased hospital mortality rates. The description of this process and the associated results may influence practice and resource allocation strategies in similar clinical environments.
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah 84108, USA. jeff.robison@hsc.utah.edu
Jeff A
JA
Robison
Zahida P
ZP
Ahmad
Carl A
CA
Nosek
Charlotte
C
Durand
Annie
A
Namathanga
Robert
R
Milazi
Ann
A
Thomas
Joyce V
JV
Soprano
Charles
C
Mwansambo
Peter N
PN
Kazembe
Susan B
SB
Torrey
D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D046688:Child Mortality; D004632:Emergency Medical Services; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D014218:Triage