Outcome of children admitted to a general highcare unit in a regional hospital in the Western Cape, South Africa

Abstract

Globally, more than 10 million children die annually, and the majority of these deaths occur in sub-Saharan Africa (41%) and southern Asia (34%), where under-5 mortality is attributed mainly to diarrhoea, pneumonia, measles, malaria, HIV/AIDS and malnutrition. [1,2] Neonatal deaths occur due to asphyxia, preterm delivery, sepsis and tetanus. [2] A country's epidemiological profile and health system largely dictate the implementation and development of public health interventions that will improve childhood survival. [1] Little is known about the need for paediatric high care and critical care in low-and middle-income countries, but published results indicate an inadequate quality of care with high mortality rates. [3] Lack of infrastructure, human resources and expert support leads to children being managed in general wards with low nurse-to-patient ratios, resulting in an increased risk of nosocomial infections and death. [3-6] Paediatric intensive care is defined as a 'physical space that is designated to manage critically ill children who require comprehensive and intensive healthcare' , and should be available to all children irrespective of where they live. [7] Research in developed countries suggests that paediatric intensive care units (PICUs) should be centralised with good retrieval services to ensure safe access. There is no clear guidance regarding the infrastructure of a PICU in a low-or middle-income country where transport services often are weak or non-existent. [8] Transfer of critically ill children poses a challenge in South Africa (SA), and a study from Cape Town revealed a high incidence of transfer-related adverse events in children transferred from non-academic metropolitan hospitals to tertiary care centres. [9] Critically ill children are, therefore, often managed by non-specialist staff in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units. [9] This study was done to determine the outcome of neonates and children admitted to a general high-care unit under the care of paediatricians at a large regional hospital in the Western Cape Province, SA. Methods The study was conducted at the large regional hospital in Worcester, SA. Worcester Hospital is the regional hospital for the Winelands/ Overberg region of the Western Cape, with ~1 million inhabitants, of whom 1.6% were <1 year of age. The infant mortality and childhood mortality rates at the time of the study were 25.3 and 31.2/1 000 live births, respectively. [10] The hospital has a five-bed general high-care unit. One of these beds is dedicated to paediatric care. The care of neonates and children admitted to the high-care unit takes place under the supervision of a paediatrician, supported by either a paediatric registrar, medical officer or intern depending on the call list. The nursing staff includes six registered nurses trained in adult intensive care and one registered nurse trained in paediatric intensive care. Child...

The essence, opportunities and threats to Advanced Practice Nursing in Sub-Saharan Africa: A scoping review

“…These children who have little parental care due to parent's disease status are exposed to many dangerous situations.Children living with diseased parents are at high risk of cross infection. There is need for community based programmes to identify and manage children living with mother who are suffering from HIV-related illnesses.African countries must give enough attention to protection of children against HIV/AIDs and its related sicknesses.51.(Kruger et al, 2016) South Africa “Outcome of children admitted to a general high-care unit in a regional hospital in the Western Cape, South Africa” To determine the prognosis of children admitted to a general healthcare unit in Cape Town South AfricaRetrospective descriptiveMain causes of death are Lower respiratory tract infections, acute gastroenteritis, asphyxia, and prematurity. 70% of the children admitted were treated and discharged.52.(Lake, 2014), South Africa “Children's rights education: An imperative for health professionals” To describe the lessons learned from a short course on children's right and child law for health in cape town, South Africa.Discussion paperThe course creates the opportunity for healthcare workers to reflect on their child care practices.…”

An assessment of critically ill children admitted to a general high-care unit in a regional hospital in Western Cape, South Africa

“…[15] Nevertheless, another study at Worcester Hospital, Western Cape, showed a good outcome in children admitted to a mixed HCU at a regional hospital. [16] Other outcome modalities arising from paediatric critical care in the developed world are mortality prediction scores such as the Paediatric Index of Mortality (PIM) score, [17,18] which is used as a tool to assess mortality risk. The standardised mortality ratio (SMR) can subsequently be calculated to provide a ratio of expected to observed deaths, which is used to compare care units.…”

“…[28] The overall low mortality reflects a good outcome. [16,25] The number of deaths occurring in the first few days of admission reflects the severity of critical illness in the initial period. [28] The observed trend of death occurring in younger children is in keeping with other studies.…”

“…[39] The relatively higher number of deaths observed in this study, compared with one-year statistics from Worcester Hospital in 2008 -2009 (n=12/185), may be explained by multiple factors. [16] In that study, transferred patients were not assessed further for survival at the tertiary centre. [16] The relative ease of transfer to the tertiary PICU due to closer proximity and access by road may have contributed to a lower mortality rate.…”

“…[16] In that study, transferred patients were not assessed further for survival at the tertiary centre. [16] The relative ease of transfer to the tertiary PICU due to closer proximity and access by road may have contributed to a lower mortality rate. [40,41] To our knowledge, this is the first study to apply the PIM3 score to a critical-care unit at regional level (i.e.…”