TY - JOUR
T1 - Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings
T2 - a hospital-based cross-sectional study
AU - Shawon, Riffat Ara
AU - Denno, Donna
AU - Tickell, Kirkby D.
AU - Atuhairwe, Michael
AU - Bandsma, Robert
AU - Mupere, Ezekiel
AU - Voskuijl, Wieger
AU - Mbale, Emmie
AU - Ahmed, Tahmeed
AU - Chisti, Md Jobayer
AU - Saleem, Ali Faisal
AU - Ngari, Moses
AU - Diallo, Abdoulaye Hama
AU - Berkley, James
AU - Walson, Judd
AU - Means, Arianna Rubin
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2024.
PY - 2024/3/8
Y1 - 2024/3/8
N2 - Objectives This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings. Design and setting We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries. Participants A total of 2796 children aged 2-23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study. Primary outcome measures We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations. Results Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted. Conclusions Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
AB - Objectives This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings. Design and setting We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries. Participants A total of 2796 children aged 2-23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study. Primary outcome measures We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations. Results Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted. Conclusions Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
UR - http://www.scopus.com/inward/record.url?scp=85187514788&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2023-078404
DO - 10.1136/bmjopen-2023-078404
M3 - Article
C2 - 38458789
SN - 2044-6055
VL - 14
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e078404
ER -