title: Quality of inpatient pediatric case management for four leading causes of child mortality at six government-run Ugandan hospitals.
abstract: BACKGROUND
  A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.
  
  
  METHODS
  All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.
  
  
  RESULTS
  A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.
  
  
  CONCLUSIONS
  Appropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality improvement initiatives should target deficiencies in care unique to each health facility, and interventions should focus on the simultaneous management of multiple diagnoses.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Sears
authors.affiliation: Uganda Malaria Surveillance Project, Kampala, Uganda; Child Health & Development Centre, Makerere University, Kampala, Uganda.
authors.forename: Arthur
authors.initials: A
authors.lastname: Mpimbaza
authors.affiliation: Uganda Malaria Surveillance Project, Kampala, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kigozi
authors.affiliation: Uganda Malaria Surveillance Project, Kampala, Uganda.
authors.forename: Asadu
authors.initials: A
authors.lastname: Sserwanga
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Chang
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Bryan K
authors.initials: BK
authors.lastname: Kapella
authors.affiliation: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America; United States President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Yoon
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States of America.
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States of America.
authors.forename: Theodore
authors.initials: T
authors.lastname: Ruel
mesh_terms: D019090:Case Management / Q000592:standards*; D002648:Child; D046688:Child Mortality; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D011787:Quality of Health Care; D014454:Uganda / Q000453:epidemiology