Adherence to the national guidelines for management of children with pneumonia at Garrisa Provincial General Hospital.

Abstract

Background: Clinical Practice Guidelines for childhood illnesses including pneumonia in Kenya are contained in the basic paediatric protocols. These have been disseminated through the ETAT + course since 2007. Implementation of guidelines into care has been shown to reduce case fatality from pneumonia by 36%. Objectives: The study set to establish the level of and factors associated with adherence to the National guidelines on management of pneumonia in children aged 2 – 59 months. Design: Hospital based cross sectional study. Setting: The paediatric department of Garissa Provincial General Hospital (PGH) in Kenya. Subjects: Clinical records of patients aged 2- 59 months diagnosed with pneumonia from January to June 2012 were reviewed. Health workers who participated in the care of these patients completed a self administered structured questionnaire. Results: Guideline adherence was assessed at three levels; assessment of clinical signs and symptoms found to be 42.9% (SD ±17.3), correct classification of disease severity was 56.6% and recommended treatment of pneumonia was 27.7%. The presence of a co-morbidity and severe disease was associated with better adherence to the assessment tasks (p = 0.033 and p =0.021 respectively). Disease severity was associated with better adherence to the disease classification task (p = <0.001) and treatment task (p = 0.02). Health workers who participated in the study (n = 27) felt confident and equipped to use the guidelines. Conclusion: The levels of adherence were low. Diseases severity was associated with better adherence at all levels. Assessment of pneumonia was improved in the presence of co morbidity.