title: Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia.
abstract: METHODS
  Gondar University Hospital (GUH) is a resource-limited tertiary care hospital in northern Ethiopia.
  
  
  OBJECTIVE
  To evaluate the aggregate effect of care standardization, institutional guidelines, and simulation-based training on pediatric mortality at a resource-limited hospital.
  
  
  METHODS
  Uncontrolled pre-post study. GUH in-patients aged from 30 days to 14 years were included in the program evaluation (baseline 11 September-18 November 2010; intervention 19 September-9 December 2011). Interns attached to the GUH pediatrics department from 6 September to 9 December 2011 were included in the training evaluation. Institution-specific management guidelines were prepared for choking, respiratory distress, dehydration, sepsis, congestive heart failure, coma, and seizure. Approval for the protocols was obtained from each pediatric faculty member. Interns received a 3.5 h simulation-based training in triage, procedural skills, and protocol usage. Primary outcome was overall deaths (%); secondary outcomes were deaths within 24 h of admission (%) and median pre/post-training emergency management test scores (%).
  
  
  RESULTS
  No difference in mortality (OR 0.72, 95%CI 0.40-1.29, P = 0.265) or first 24 h mortality (crude OR 0.97, 95%CI 0.37-2.55) was observed. Trainee examination scores improved from 33% to 74% (P < 0.001).
  
  
  CONCLUSIONS
  Combining care standardization, management protocols, and simulation-based training did not reduce mortality among pediatric in-patients. Focused, simulation-based training improved short-term test scores among interns.
authors.affiliation: Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Gordon
authors.affiliation: Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Shehibo
authors.affiliation: Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Tazebew
authors.affiliation: Embrace, Yorkshire and Humber Infant and Childrens Transport Service, Sheffield, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Huddart
authors.affiliation: Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kadir
authors.affiliation: Yale University Global Health Leadership Institute, Eugene, Oregon, USA.
authors.forename: N
authors.initials: N
authors.lastname: Allen
authors.affiliation: Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA.
authors.forename: H
authors.initials: H
authors.lastname: Draper
authors.affiliation: Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Kokeb
keywords: Africa; children; continuing medical educations; emergency care; mortality