Diana Silimperi, MD¹, Maina Boucar, MD, MPH¹, Tsigereda Gebrehiwot, MD², Oscar Nuñez, MD³, Michael Mehari, MD⁴, Ivonne Gomez, MD³, Zakary Saley, MD⁴, and Lauri Winter⁴. (1) Deputy Director, Quality Assurance Project, University Research Co., LLC, Suite 600, 7200 Wisconsin Avenue, Bethesda, MD 20814-4811, 301-941-8407, dsilimperi@msh.org, (2) Ministry of Health of Eritrea, 7200 Wisconsin Avenue Suite 600, Bethesda, MD 20814, (3) Proyecto de Garantia de Calidad, Km 5, carretera a Masaya, Plaza Fountain Blue, Modulo 9, Managua, Nicaragua, (4) Quality Assurance Project, 7200 Wisconsin Avenue, Bethesda, MD 20814-4811

WHO studies indicate that 10-20% of sick children treated with IMCI at health centers need referral to hospitals for life-saving treatment. New guidelines from WHO (2000) provide evidence-based standards for case management of children with severe infections or malnutrition, but they have been introduced in only a few countries. In order to accelerate their spread, a collaborative approach to improving inpatient hospital case management of children 0-5 years has been launched in Eritrea, Nicaragua, and Niger. Within each country, an interactive assessment was undertaken to identify current practices of care, contrast current practices with WHO’s guidelines, introduce the guidelines, and begin improvement actions.

For the initial assessments, over 800 children were directly observed in 39 hospitals in the three participating countries; children receiving treatment according to the guidelines ranged from about 6% in Niger to 45% in Nicaragua. In all countries, case management of severe malnutrition fared the worst. Major areas for improvement included: emergency triage, assessment and treatment, patient monitoring, and nutritional support for hospitalized children. Most of the improvements identified required better use of existing resources, and should result in cost savings as well as improved clinical outcomes. The presentation will also include results of ongoing improvement efforts.

With more countries introducing IMCI at primary care facilities, attention must be directed to the survival of children who need referral and care at first level hospitals. In three diverse developing countries, an interactive assessment coupled with collaborative improvement is being used to bring rapid results and scale up improvement.

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