title: Paediatric tracheostomy and ventilation home care with challenging socio-economic circumstances in South Africa.
abstract: BACKGROUND
  Children discharged home with a tracheostomy need a safe home environment and access to health care. We described the indications, clinical characteristics, socio-economic circumstances and outcomes of children enroled in a tracheostomy home care programme in South Africa.
  
  
  METHODS
  We performed a retrospective chart review of children receiving a tracheostomy and enroled in the Breatheasy programme at the Red Cross War Memorial Children's Hospital, Cape Town. Medical and background characteristics were recorded. Influences of socio-economic variables and underlying medical conditions on length of hospital stay, unplanned readmissions and mortality in the first year after discharge were evaluated.
  
  
  RESULTS
  In the period 2008-2012, 157 patients were discharged home with a tracheostomy. Median hospital stay after tracheostomy insertion was significantly longer when parents had incomplete schooling compared to completed secondary school or higher education; 30 days (IQR 21-53) versus 23 days (IQR 16-33), respectively. Unplanned readmissions in the first year were documented for 72 patients (45.9%). The risk for unplanned readmission was 2.6 times higher in families with substance abuse the risk of respiratory infections was two-fold in case of household cigarette smoke exposure (OR 2.3.) Tracheostomy-related mortality was low (1.2%). An underlying medical condition was the only independent significant risk factor for mortality (OR 5.1, 95% CI 1.8-14.3).
  
  
  CONCLUSIONS
  This study demonstrates that despite difficult socio-economic circumstances, home ventilation of children with a tracheostomy is safe, provided caregivers are adequately trained and supported.
authors.affiliation: Intensive Care Unit and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: ilsegroenendijk@gmail.com.
authors.forename: Ilse
authors.initials: I
authors.lastname: Groenendijk
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Booth
authors.affiliation: Intensive Care Unit and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health University of Cape Town; and Paediatric Intensive Care Unit Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Argent
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Marco
authors.initials: M
authors.lastname: Zampoli
mesh_terms: D000293:Adolescent; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa; D014139:Tracheostomy
keywords: Home care; Resource-limited; Socio-economic circumstances; Tracheostomy