Adherence To Clinical Guidelines In The Management Of Diarrhoea Diseases In Children Aged Below Five Years Admitted At Mama Lucy Hospital, Nairobi

Abstract

Introduction: Globally, diarrheal diseases exert significant burden of childhood morbidity and mortality. Developing countries of Southern Asia and Sub-Saharan African bear the greatest impact accounting for over 83% of the global burden of diarrheal disease. Despite the availability of evidence-based diarrhea management protocols, it has remained the second leading cause of mortality among children below 5 years and is responsible for an estimated 1.5 million children deaths annually. However, adherence to the clinical guidelines has remained suboptimal impacting on treatment outcomes negatively. The aim of this study, therefore, was to evaluate levels of adherence to clinical guidelines and assess associated health outcomes among children aged 5 years and below admitted with diarrhea at Mama Lucy Kibaki hospital in Nairobi. Methodology: A retrospective Medical Record Review (MRR) study was conducted at Mama Lucy hospital to evaluate levels of adherence to WHO clinical guidelines in the treatment of diarrhea disease among children aged 5 years and below. Patient’s medical data was abstracted using a specially designed screening tool and a questionnaire developed from the clinical guidelines. Data collected was imported into SPSS version 21 for analysis and reporting. Descriptive statistics were computed and presented for continuous and categorical variables in tables, graphs and charts. Mean with corresponding standard deviations and percentages were reported. Simple logistic analysis was used to evaluate the association of different levels of adherence to clinical outcomes (status on exit from hospital and length of hospital stay). Results: Diarrhea continues to rank among the top burden of disease at Mama Lucy hospital accounting for 21% among children aged below 5 years and is secondary only to pneumonia 31%. Adherence to clinical guidelines remains relatively low at 47% and a child who had not been assessed on admission for signs and symptoms of dehydration had an increased risk of dying by 16 times (OR 16.25, 95% CI 3.09-89.6, p-value 0.001) compared to a child who had been appropriately assessed. Excessive use of intravenous fluids, antidiarrheal drugs and over prescription of antibiotics are main impediments to adherence. The study recommends harmonized training to all cadres of staff on implementation of clinical guidelines, reinforced protocols and guidelines in clinical areas and close monitoring of implementation processes. In addition, a public vi health approach embracing multiple strategies such as health education and nutrition is recommended. Conclusion: Diarrhea continue to impact on morbidity and mortality despite being preventable. A multi-prong strategy is required to enhance management and control of diarrhea in children