Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study

Author:

Shawon Riffat AraORCID,Denno DonnaORCID,Tickell Kirkby DORCID,Atuhairwe Michael,Bandsma RobertORCID,Mupere Ezekiel,Voskuijl WiegerORCID,Mbale Emmie,Ahmed TahmeedORCID,Chisti Md JobayerORCID,Saleem Ali FaisalORCID,Ngari MosesORCID,Diallo Abdoulaye Hama,Berkley JamesORCID,Walson JuddORCID,Means Arianna RubinORCID

Abstract

ObjectivesThis study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.Design and settingWe used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries.ParticipantsA 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 measuresWe 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.ResultsFully 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.ConclusionsNon-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.

Funder

National Institutes of Health

Bill and Melinda Gates Foundation

Publisher

BMJ

Reference30 articles.

1. UNICEF . Under-five mortality. 2019. Available: https://data.unicef.org/topic/child-survival/under-five-mortality/ [Accessed 12 Dec 2021].

2. Maternal and child undernutrition and overweight in low-income and middle-income countries

3. Hug L , Sharrow D , You D . Levels & trends in child mortality. 2017. Available: https://reliefweb.int/sites/reliefweb.int/files/resources/Levels-and-trends-in-child-mortality-IGME-English_2021.pdf

4. TheGlobal strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience

5. Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis

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