Health workers practice in the management of acute diarrhoea among children aged 6-59 months admitted to Juba Teaching Hospital.South Sudan

Abstract

Introduction:Diarrhoea is one of the leading causes of mortality and morbidity in children under five worldwide. In South Sudan, it accounts for 42.9% of under 5 mortality. The clinical outcomes for diarrhea correlate with the quality of hospital care. Therefore, to maintain the quality of hospital care, health workers should utilize evidence based guidelines in managing diarrhea, such as the WHO/IMCI case management of acute diarrhea, which has been introduced by the ministry of health to decrease mortality & morbidity. In this study, we assessed the health workers’ practices regarding management of acute diarrhea in children aged 6-59months. Objectives: To determine the proportion of children aged 6-59 months with acute diarrhea at JTH who are assessed for clinical signs of dehydration and correctly classified and correctly prescribed IV fluids and/or ORS for management of dehydration as per WHO guidelines. To describe the knowledge of health workers with regards to the assessment and classification of diarrhea and the clinical indications of rehydration fluids in the management of children with acute diarrhea and their view on the availability of commodities necessary for management of acute diarrhea. Study Design: The study was a cross-sectional study comprising two parts. The first part was a hospital based retrospective audit of records of Children aged 6-59months admitted with acute diarrhea at the Juba Teaching Hospital between March and June 2014, whereas the second part was interviews of health workers regarding their knowledge on the management of acute diarrhea in Children aged 6-59 months. Study Area: Juba Teaching Hospital (JTH) pediatric ward. Methodology: The standard WHO/IMCI for assessment of health workers' performance in the management of children under 5years illnesses was adapted and used in the study. Questionnaires and interviews were used to collect data on health workers’ knowledge and practice in the management of acute diarrhea. Descriptive analysis was used to determine the means, frequencies and proportions of the various variables. All the analyses were done using SPSS software version 21. Results: A total of 39 health workers were interviewed and 202 medical records of children admitted at the Juba teaching hospital with acute diarrhea between March and June 2014 were examined. The majority(75.74%) of the children assessed with diarrhea were 6-24 months old. Most patients were poorly assessed and the most common sign assessed was (75.12%) patients for sunken eyes and the least assessed sign was ability to drink/breast feed at (34.32%). Seventy five percent of patients were classified correctly according to WHO guidelines and 61% of patients received the correct choice of fluid therapy as per the WHO guideline. The most commonly known danger sign was the child who vomits everything (46.2%) and the least known sign was a child with a change in level of consciousness. Health workers' knowledge in how to assess the hydration state of the children was poor (below 50%) especially in the assessing level of consciousness and ability to drink or breastfeed, while their knowledge in the use of hydration fluid was good (above 50%). Of the commodities for management, ORS was available 87.1% of the time, followed by Ringer’s lactate at 56.4%, while the rest were available for less than 50% of the time Conclusion: There is inadequate assessment and documentation of the signs and symptoms of dehydration in the children admitted with acute watery diarrhea at JTH. There in inadequate knowledge in assessment of dehydration and use of rehydration fluid therapy. There are adequate supplies needed in the management of acute watery diarrhea at the at JTH which are mostly available.