Browsing School of Public Health by Subject "Malnourished children"
Now showing items 1-3 of 3
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Puoane, Thandi; Sanders, David; Ashworth, Ann; Chopra, Mickey; Strasser, Susan; McCoy, David (Oxford University Press, 2004)[more][less]
Abstract: OBJECTIVE. 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. URI: http://hdl.handle.net/10566/294 Files in this item: 1
PuoaneHospitalManagement2004.pdf (2.647Mb) -
Puoane, Thandi; Sanders, David; Ashworth, Ann; Ngumbela, Modesta (Democratic Nursing Organisation of South Africa, 2006)[more][less]
Abstract: A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Severe malnutrition is a major cause of death among paediatric patients in many hospitals in South Africa. A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Focus group discussions were conducted in isiXhosa following a semi-structured discussion guide. Three themes emerged from these discussions, i.e. blame was placed on the mothers for not giving adequate care, malnourished children were valued less than those with other conditions, and resentment that nurses felt towards caregivers. underlying reasons for negative attitudes towards severely malnourished children and their caregivers were misunderstandings of the causes of severe malnutrition, misinterpretation of clinical signs,especially poor appetite and and high mortality during treatment.However, successful application of the treatment guidelines altered these perceptions and helped nurses to have a better understanding of the causes of the presenting clinical signs. These nurses have begun advocating for raised awareness and the need to include the WHO Ten Steps of treatment in the nursing curricula and in-service training. A cadre of volunteer nurse-trainers has been formed in Eastern Cape. Experience in this province has shown that in-service training changes attitudes to malnutrition and treatment practices, as well as saving lives. URI: http://hdl.handle.net/10566/297 Files in this item: 1
PuoaneTrainingNurses2006.pdf (666.8Kb) -
Puoane, Thandi; Katie, Cuming; Sanders, David; Ashworth, Ann (Oxford University Press, 2008)[more][less]
Abstract: Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were <10% in the successful hospitals and >30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training programmes to improve health worker performance can be thwarted. URI: http://hdl.handle.net/10566/295 Files in this item: 1
PuoaneHospitals2008.pdf (102.3Kb)
Now showing items 1-3 of 3