Large-scale data reporting of paediatric morbidity and mortality in developing countries: it can be done.
Although the WHO recommends all countries use International Classification of Diseases (ICD)-10 coding for reporting health data, accurate health facility data are rarely available in developing or low and middle income countries. Compliance with ICD-10 is extremely resource intensive, and the lack of real data seriously undermines evidence-based approaches to improving quality of care and to clinical and public health programme management. We developed a simple tool for the collection of accurate admission and outcome data and implemented it in 16 provincial hospitals in Papua New Guinea over 6 years. The programme was low cost and easy to use by ward clerks and nurses. Over 6 years, it gathered data on the causes of 96,998 admissions of children and 7128 deaths. National reports on child morbidity and mortality were produced each year summarising the incidence and mortality rates for 21 common conditions of children and newborns, and the lessons learned for policy and practice. These data informed the National Policy and Plan for Child Health, triggered the implementation of a process of clinical quality improvement and other interventions to reduce mortality in the neediest areas, focusing on diseases with the highest burdens. It is possible to collect large-scale data on paediatric morbidity and mortality, to be used locally by health workers who gather it, and nationally for improving policy and practice, even in very resource-limited settings where ICD-10 coding systems such as those that exist in some high-income countries are not feasible or affordable.
Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Victoria, Australia School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
Trevor
T
Duke
Disease Surveillance Branch, PNG National Department of Health, Waigani, NCD, Papua New Guinea.
Edilson
E
Yano
Electronic Medical Record, Royal Children's Hospital, Parkville, Victoria, Australia.
Adrian
A
Hutchinson
Department of Paediatrics, Goroka General Hospital, Goroka, Eastern Highlands, Papua New Guinea.
Ilomo
I
Hwaihwanje
Department of Paediatrics, Modillon Hospital, Madang, Madang Province, Papua New Guinea.
Jimmy
J
Aipit
Department of Paediatrics, Buka Hospital, Buka, Autonomous Region of Bouganville, Papua New Guinea.
Mathias
M
Tovilu
Department of Paediatrics, Kimbe Hospital, Kimbe, West New Britain Province, Papua New Guinea.
Tarcisius
T
Uluk
Department of Paediatrics, Angau Hospital, Lae, Morobe Province, Papua New Guinea.
Theresia
T
Rongap
Department of Paediatrics, Rabaul Hospital, Rabaul, East New Britain, Papua New Guinea.
Beryl
B
Vetuna
PNG National Department of Health, Family Health Services, Port Moresby, NCD, Papua New Guinea.
William
W
Lagani
Department of Paediatrics, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea.
James
J
Amini
D000293:Adolescent; D002648:Child; D002662:Child Health Services; D046688:Child Mortality; D002675:Child, Preschool; D003906:Developing Countries; D006801:Humans; D007231:Infant, Newborn; D038801:International Classification of Diseases; D009017:Morbidity; D010219:Papua New Guinea / Q000453:epidemiology; D012107:Research Design
Data Collection; Epidemiology; Health Service; Outcomes research; Tropical Paediatrics