Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) networkResearch in context

• Published in: EClinicalMedicine Vol. 63; p. 102198
• Main Authors: Chris A. Rees, Kitiezo Aggrey Igunza, Zachary J. Madewell, Victor Akelo, Dickens Onyango, Shams El Arifeen, Emily S. Gurley, Mohammad Zahid Hossain, Afruna Rahman, Muntasir Alam, J. Anthony G. Scott, Nega Assefa, Lola Madrid, Anteneh Belachew, Haleluya Leulseged, Karen L. Kotloff, Samba O. Sow, Milagritos D. Tapia, Adama Mamby Keita, Diakaridia Sidibe, Antonio Sitoe, Rosauro Varo, Sara Ajanovic, Quique Bassat, Inácio Mandomando, Beth A. Tippett Barr, Ikechukwu Ogbuanu, Carrie Jo Cain, Ima-Abasi Bassey, Ronita Luke, Khadija Gassama, Shabir Madhi, Ziyaad Dangor, Sana Mahtab, Sithembiso Velaphi, Jeanie du Toit, Portia C. Mutevedzi, Dianna M. Blau, Robert F. Breiman, Cynthia G. Whitney, Fatima Solomon, Gillian Sorour, Hennie Lombaard, Jeannette Wadula, Karen Petersen, Martin Hale, Nelesh P. Govender, Peter J. Swart, Sanjay G. Lala, Richard Chawana, Yasmin Adam, Amy Wise, Ashleigh Fritz, Nellie Myburgh, Pedzisai Ndagurwa, Cleopas Hwinya, Sanwarul Bari, Shahana Parveen, Mohammed Kamal, A.S.M. Nawshad Uddin Ahmed, Mahbubul Hoque, Saria Tasnim, Ferdousi Islam, Farida Ariuman, Mohammad Mosiur Rahman, Ferdousi Begum, K. Zaman, Mustafizur Rahman, Dilruba Ahmed, Meerjady Sabrina Flora, Tahmina Shirin, Mahbubur Rahman, Joseph Oundo, Alexander M. Ibrahim, Fikremelekot Temesgen, Tadesse Gure, Addisu Alemu, Melisachew Mulatu Yeshi, Mahlet Abayneh Gizaw, Stian Orlien, Solomon Ali, Peter Otieno, Peter Nyamthimba Onyango, Janet Agaya, Richard Oliech, Joyce Akinyi Were, Dickson Gethi, Sammy Khagayi, George Aol, Thomas Misore, Harun Owuor, Christopher Mugah, Bernard Oluoch, Christine Ochola, Sharon M. Tennant, Carol L. Greene, Ashka Mehta, J. Kristie Johnson, Brigitte Gaume
• Format: Journal Article
• Language: English
• Published: Elsevier 01.09.2023
• Subjects: Childhood; Clinical care; Guideline adherence; Mortality
• ISSN: 2589-5370; 2589-5370

Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1–59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016–June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation: Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding: Bill & Melinda Gates Foundation.