EClinicalMedicine (Sep 2023)

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

  • 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,
  • Sithembiso Velaphi,
  • 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,
  • Rima Koka,
  • Karen D. Fairchild,
  • Diakaridia Kone,
  • Sharon M. Tennant,
  • Ashka Mehta,
  • Doh Sanogo,
  • Uma U. Onwuchekwa,
  • Nana Kourouma,
  • Seydou Sissoko,
  • Cheick Bougadari Traore,
  • Jane Juma,
  • Kounandji Diarra,
  • Awa Traore,
  • Tiéman Diarra,
  • Kiranpreet Chawla,
  • Tacilta Nhampossa,
  • Zara Manhique,
  • Sibone Mocumbi,
  • Clara Menéndez,
  • Khátia Munguambe,
  • Ariel Nhacolo,
  • Maria Maixenchs,
  • Andrew Moseray,
  • Fatmata Bintu Tarawally,
  • Martin Seppeh,
  • Ronald Mash,
  • Julius Ojulong,
  • Babatunde Duduyemi,
  • James Bunn,
  • Alim Swaray-Deen,
  • Joseph Bangura,
  • Amara Jambai,
  • Margaret Mannah,
  • Okokon Ita,
  • Cornell Chukwuegbo,
  • Sulaiman Sannoh,
  • Princewill Nwajiobi,
  • Dickens Kowuor,
  • Erick Kaluma,
  • Oluseyi Balogun,
  • Solomon Samura,
  • Samuel Pratt,
  • Francis Moses,
  • Tom Sesay,
  • James Squire,
  • Joseph Kamanda Sesay,
  • Osman Kaykay,
  • Binyam Halu,
  • Hailemariam Legesse,
  • Francis Smart,
  • Sartie Kenneh,
  • Soter Ameh,
  • Sartie Kenneh,
  • Jana Ritter,
  • Tais Wilson,
  • Jonas Winchell,
  • Jakob Witherbee,
  • Navit T. Salzberg,
  • Jeffrey P. Koplan,
  • Margaret Basket,
  • Ashutosh Wadhwa,
  • Kyu Han Lee,
  • Valentine Wanga,
  • Roosecelis Martines,
  • Shamta Warang,
  • Maureen Diaz,
  • Jessica Waller,
  • Shailesh Nair,
  • Lucy Liu,
  • Courtney Bursuc,
  • Kristin LaHatte,
  • Sarah Raymer,
  • John Blevins,
  • Solveig Argeseanu,
  • Kurt Vyas,
  • Manu Bhandari

Journal volume & issue
Vol. 63
p. 102198

Abstract

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Summary: 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.

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