Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114667

Thandi Puoane, Dr PH, School of Public Health, University of the Western Cape, Private Bag X 17, Bellville, Cape Town, 7535, South Africa, 27 219593084, tpuoane@uwc.ac.za, Katie Cuming, BM, DCH, London School of Hyggiene and Tropical Medicine, Public Health Nutrition Unit, Keppel Street, London WC1E 7HT, United Kingdom, David Sanders, MB, ChB, MRCP, School of Public Health, School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa, Ann Ashworth, BSc, PhD, Nutrition, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, and Mickey Chopra, BSc, BM, DCH, MS, HSRU, Medical Research Council, SOPH, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.

Malnutrition remains a major cause of mortality and morbidity among children in developing countries. Inappropriate treatment of severe cases leads to many unnecessary deaths and WHO has developed guidelines to improve the quality of in-patient care. A programme of training, support and advocacy to implement the guidelines has been initiated in the poorest region of Eastern Cape Province, one of South Africa's most under-resourced provinces. Eleven hospitals have received similar training and support. Overall, case-fatality rates remain unacceptably high (at about 30%) as the guidelines are not always followed. However few hospitals, although similar in all other respects, perform consistently better than the majority with case-fatality rates of about 15%. Objectives: To explore factors associated with success, as well as factors constraining further improvement, and to inform national and international policies. Methods: Two successful and two failing hospitals were purposely selected based on their case-fatality rates. Ward procedures, supervision, and interactions among staff and between nurses and mothers, were observed. In-depth interviews with paediatric staff, and focus group discussions, were held, and patient records reviewed. Results: In the successful hospitals, senior nurses took a more active role in training, supervising and motivating junior staff and in guiding inexperienced doctors compared to senior nurses in poorly performing hospitals. They also had closer relationship with mothers and supervised them better. Support from senior managers and multi-sectoral collaboration were also stronger. Conclusion: Leadership and support have a significant bearing on the effectiveness of treatment guidelines and training in improving the quality of care.

Learning Objectives:

• To describe factors associated with success, as well as factors constraining further improvement, and to inform national and international policies.

Keywords: Child Health, Quality of Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.