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

Riffat Ara Shawon, Donna Denno, Kirkby D. Tickell, Michael Atuhairwe, Robert Bandsma, Ezekiel Mupere, Wieger Voskuijl, Emmie Mbale, Tahmeed Ahmed, Md Jobayer Chisti, Ali Faisal Saleem, Moses Ngari, Abdoulaye Hama Diallo, James Berkley, Judd Walson, Arianna Rubin Means

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article numbere078404
JournalBMJ Open
Volume14
Issue number3
DOIs
Publication statusPublished - 8 Mar 2024

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this