Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries

English, Mike; Mwaniki, Paul; Julius, Thomas; Chepkirui, Mercy; Gathara, David; Ouma, Paul; Cherutich, Peter; Okiro, Emelda A.; Snow, Robert W.

doi:10.1186/s12916-018-1024-8

Cited by 41 publications

(46 citation statements)

References 40 publications

(45 reference statements)

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“…In lower-income countries, consistent and accurate measurement of hospital mortality for selected services would be an important advance. 204 One approach for system competence measurement is to consider conditions or procedures that require functional integration within a health-care platform and identify process or outcome measures therein as tracer indicators. For example, indicators such as blood transfusion delay, surgical site infection, and peri operative mortality rate provide insight into hospital care quality as a whole.…”

Section: Measuring Patient-reported Outcome Measures (Proms) For Pregmentioning

confidence: 99%

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

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The Lancet Global Health Commission and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts. In this Commission, we assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. Moving to a highquality health system-one that improves health and generates confidence and economic benefits-is primarily a political, not technical, decision. National governments need to invest in high-quality health systems for their own people and make such systems accountable to people through legislation, education about rights, regulation, transparency, and greater public participation. Countries will know that they are on the way towards a high-quality, accountable health system when health workers and policymakers choose to receive health care in their own public institutions. Components Quality impacts Better health Level and distribution of patient-reported outcomes: function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering Confidence in system Satisfaction, recommendation, trust, and care uptake and retention Economic benefit Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection Processes of care Competent care and systems Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, counselling, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management Positive user experience Respect: dignity, privacy, non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use Foundations Population Individuals, families, and communities as citizens, producers of better health outcomes, and system users: health needs, knowledge, health literacy, preferences, and cultural norms Governance Leadership: political commitment, change management; policies: regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioural architecture, and public health functions; financing: funding, fund pooling, insurance and purchasing, provider contracting and payment; learning and improvement: institutions for evaluation, measurement, and improvement, learning communities, and trustworthy data; intersectoral: roads, transport, wa...

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Section: Measuring Patient-reported Outcome Measures (Proms) For Pregmentioning

confidence: 99%

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

Self Cite

2,260

2,275

View full text Add to dashboard Cite

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“…Inevitably, the completeness and reliability of information available within hospital data systems depends upon resources and the intended objectives of surveillance programs. Hospital surveillance provides unique opportunities to monitor the changing clinical epidemiology of severe malaria and other febrile illnesses and with minimal investment could be implemented in a sustained form at national sentinel sites [ 62 ]. Investments are required for admission and data clerks, information and data systems and ensuring a basic minimum supply of laboratory supplies.…”

Section: Discussionmentioning

confidence: 99%

The age-specific incidence of hospitalized paediatric malaria in Uganda

et al. 2020

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Background Understanding the relationship between malaria infection risk and disease outcomes represents a fundamental component of morbidity and mortality burden estimations. Contemporary data on severe malaria risks among populations of different parasite exposures are scarce. Using surveillance data, we compared rates of paediatric malaria hospitalisation in areas of varying parasite exposure levels. Methods Surveillance data at five public hospitals; Jinja, Mubende, Kabale, Tororo, and Apac were assembled among admissions aged 1 month to 14 years between 2017 and 2018. The address of each admission was used to define a local catchment population where national census data was used to define person-year-exposure to risk. Within each catchment, historical infection prevalence was assembled from previously published data and current infection prevalence defined using 33 population-based school surveys among 3400 children. Poisson regression was used to compute the overall and site-specific incidences with 95% confidence intervals. Results Both current and historical Plasmodium falciparum prevalence varied across the five sites. Current prevalence ranged from < 1% in Kabale to 54% in Apac. Overall, the malaria admission incidence rate (IR) was 7.3 per 1000 person years among children aged 1 month to 14 years of age (95% CI: 7.0, 7.7). The lowest rate was described at Kabale (IR = 0.3; 95 CI: 0.1, 0.6) and highest at Apac (IR = 20.3; 95 CI: 18.9, 21.8). There was a correlation between IR across the five sites and the current parasite prevalence in school children, though findings were not statistically significant. Across all sites, except Kabale, malaria admissions were concentrated among young children, 74% were under 5 years. The median age of malaria admissions at Kabale hospital was 40 months (IQR 20, 72), and at Apac hospital was 36 months (IQR 18, 69). Overall, severe anaemia (7.6%) was the most common presentation and unconsciousness (1.8%) the least common. Conclusion Malaria hospitalisation rates remain high in Uganda particularly among young children. The incidence of hospitalized malaria in different locations in Uganda appears to be influenced by past parasite exposure, immune acquisition, and current risks of infection. Interruption of transmission through vector control could influence age-specific severe malaria risk.

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“…This will enable a description of any changes in the clinical epidemiology of malaria and severe disease following the introduction of the vaccine. Hospitals provide unique settings to understanding the changing clinical epidemiology of pediatric infectious diseases and vaccine-preventable disease surveillance [ 49–54 ].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya

Akech

Chepkirui

Ogero

et al. 2019

Clinical Infectious Diseases

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Abstract Background The malaria prevalence has declined in western Kenya, resulting in the risk of neurological phenotypes in older children. This study investigates the clinical profile of pediatric malaria admissions ahead of the introduction of the RTS,S/AS01 vaccine. Methods Malaria admissions in children aged 1 month to 15 years were identified from routine, standardized, inpatient clinical surveillance data collected between 2015 and 2018 from 4 hospitals in western Kenya. Malaria phenotypes were defined based on available data. Results There were 5766 malaria admissions documented. The median age was 36 months (interquartile range, 18–60): 15% were aged between 1–11 months of age, 33% were aged 1–23 months of age, and 70% were aged 1 month to 5 years. At admission, 2340 (40.6%) children had severe malaria: 421/2208 (19.1%) had impaired consciousness, 665/2240 (29.7%) had an inability to drink or breastfeed, 317/2340 (13.6%) had experienced 2 or more convulsions, 1057/2340 (45.2%) had severe anemia, and 441/2239 (19.7%) had severe respiratory distress. Overall, 211 (3.7%) children admitted with malaria died; 163/211 (77% deaths, case fatality rate 7.0%) and 48/211 (23% deaths, case fatality rate 1.4%) met the criteria for severe malaria and nonsevere malaria at admission, respectively. The median age for fatal cases was 33 months (interquartile range, 12–72) and the case fatality rate was highest in those unconscious (44.4%). Conclusions Severe malaria in western Kenya is still predominantly seen among the younger pediatric age group and current interventions targeted for those <5 years are appropriate. However, there are increasing numbers of children older than 5 years admitted with malaria, and ongoing hospital surveillance would identify when interventions should target older children.

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Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries

Cited by 41 publications

References 40 publications

High-quality health systems in the Sustainable Development Goals era: time for a revolution

High-quality health systems in the Sustainable Development Goals era: time for a revolution

The age-specific incidence of hospitalized paediatric malaria in Uganda

The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya

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