Improving the hospital management of malnourished children by participatory research

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dc.contributor.authorPuoane, Thandi
dc.contributor.authorSanders, David
dc.contributor.authorAshworth, Ann
dc.contributor.authorChopra, Mickey
dc.contributor.authorStrasser, Susan
dc.contributor.authorMcCoy, David
dc.date.accessioned2011-12-22T09:25:37Z
dc.date.available2011-12-22T09:25:37Z
dc.date.issued2004
dc.description.abstractOBJECTIVE. To improve the clinical management of severely malnourished children in rural hospitals in South Africa. STUDY DESIGN. A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research. SETTING. Two rural Wrst-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province. MAIN MEASURES. A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care. RESULTS. Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by ∼25% in both hospitals. CONCLUSION. Participatory research led to the formation of a hospital nutrition team, which identiWed shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates.en_US
dc.description.sponsorshipHealth Systems Trusten_US
dc.identifier.citationPuoane, T., et al. (2004). Improving the hospital management of malnourished children by participatory research. International Journal for Quality in Health Care, 16 (1): 31-40en_US
dc.identifier.issn1464-3677
dc.identifier.urihttp://hdl.handle.net/10566/294
dc.language.isoenen_US
dc.privacy.showsubmittertrue
dc.publisherOxford University Pressen_US
dc.rightsThis is the author post-print version of the published article and may be freely used, provided that full acknowledgement of author and source is given.
dc.source.urihttp://dx.doi.org/10.1093/intqhc/mzh002
dc.status.ispeerreviewedtrue
dc.subjectCase fatality ratesen_US
dc.subjectIn-patient treatmenten_US
dc.subjectMalnourished childrenen_US
dc.subjectMalnutritionen_US
dc.subjectQuality of careen_US
dc.subjectParticipatory researchen_US
dc.subjectHospitals
dc.titleImproving the hospital management of malnourished children by participatory researchen_US
dc.typeArticleen_US

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