Emerging threat to the fight against child mortality

Researchers have warned that continued defiance of global clinical guidelines by health workers in developing countries, especially those in East African countries could compromise the achievement of the Millennium Development Goal Four of reducing child mortality by 2015.The study, which was carried out at Kenya’s largest referral hospital, Kenyatta National Hospital, set out to evaluate the impact of purposefully and widely disseminating Clinical Management Guidelines including Emergency Triage Assessment and Treatment Plus Admission care Training (ETAT+) to targeted clinical and nursing care providers in the general paediatric wards.The results, which were published last week in a scientific journal, PLOS ONE, further propose that more attention paid to broader implementation strategies that target institutional and organisational aspects of service delivery to further enhance quality care.It focused on three common childhood diseases; pneumonia, dehydration (due to diarrhoea) and severe malnutrition because the three diseases are known to have a high disease burden, high levels of mortality with the World Health Organisation/ Kenyan case management guidelines having remained unchanged for the last 12 years.Dr Stevenson Musiime, a paediatrician at King Faisal Hospital in Kigali, admitted that many clinicians, including those in referral hospitals, usually deviate from the recommended standard treatment guidelines.A new study by KEMRI-Wellcome Trust Researchers, however, suggests that the active dissemination of paediatric clinical guidelines can greatly improve the quality of care and service received by seriously sick children.“If health workers learn how to use guidelines during their training in major hospitals, they should be better able to support efforts to reduce childhood mortality and ultimately help in meeting the fourth Millennium Development Goal,” the report explains.Commenting on the results, Dr. Musiime said as paediatricians, regular clinical audits should be conducted to ensure compliance with the guidelines are followed.“We, however, keep writing and teaching these guidelines. At King Faisal, we do regular clinical audits which evaluate the compliance to these guidelines,” he added.The report also shows that studies in low income countries have repeatedly shown that health workers barely comply with global evidence- based clinical guidelines when managing common but serious childhood diseases.This study emphasised the need for more deliberate and targeted dissemination of the guidelines to health workers, even in large teaching hospitals in low income countries such as those in East Africa.Dr Grace Irimu, the study’s lead author, said: “Our study found that active efforts to change practices that build on the distribution of guidelines and provision of training and which engage multiple health workers, can significantly improve the uptake of nationally and internationally recommended practices”.“We also observed a fall in mortality over the same time period. However, this could be due to a number of other factors that our study could not account for.”The co-author Prof Mike English observed that the slow pace of getting evidence into routine healthcare practice is a global concern. “This work illustrates that it can be done, but also indicates that we have to do more than simply printing guidelines or running training courses. We need to actively promote new practices, work with hospitals and sustain efforts,” he said.According to a report by UNICEF of June 2012, pneumonia and diarrhoea are leading killers of the world’s youngest children, accounting for 29 percent of deaths among children under the age of five worldwide – or more than two million lives lost each year. This toll is highly concentrated in the poorest regions and countries. Nearly 90 percent of deaths due to pneumonia and diarrhoea occur in sub-Saharan Africa and South Asia.Modelled estimates suggest that by 2015, more than two million child deaths as a result of the two diseases, could be averted across the 75 countries with the highest mortality burden if national coverage of key interventions were raised to the level of the richest 20 percent of households in each country.