Clinicians adherence to standard treatment guidelines in managing children with non-malaria febrile illnesses at Temeke and Mwananyamala hospitals in Dar es salaam
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Date
2019-10
Authors
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Journal ISSN
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Publisher
Hubert Kairuki Memorial University
Abstract
Background- Non-malarial febrile illnesses among children less than 5 years of age
are an important cause of morbidity and mortality as they have been shown to cause
a higher mortality than malaria globally, even in malaria-endemic areas, including
Tanzania. However there is a dilemma in diagnostic accuracy in low income
countries which lead to wrong diagnoses and treatment.
Objective- The objective this study was to determine the level of clinician's
adherence to standard treatment guidelines in managing children below five years
with non-malaria febrile illnesses at Temeke and Mwananyamaia Hospitals in Dar es
Salaam, Tanzania.
Methodology: This was a descriptive cross-sectional hospital based study conducted
at Temeke and Mwananyamaia from May to July 2019. Medical records of children
less than five years of age with non-malaria febrile illnesses at these hospitals were
reviewed to determine how they were managed. Important information concerning
their diagnoses and the kind of treatment administered were recorded on a structured
questionnaire administered by the author. Twenty of the attending clinicians were
interviewed using a structured questionnaire to determine if they were using the
standard treatment guidelines and if not, the factors behind non-adherence to the
available guidelines.
Results -Included in the study were 149 charts of children less than five years who
presented with non-malaria febrile illnesses with mean temperature of 38.5°C. The
mean age was 22 months. Males were 77 (51.7%) and females were 72(48.3%). The
main causes of admission were pneumonia, Septicemia and Meningitis 39(26.17%),
35(23.49%) and 26(17.47%) respectively. In this study the overall prevalence of
adherence to standard treatment guidelines was 43(29%). Children who were
negative for malaria but treated with antimalarial were 21(14.1%). The study
identified 114 (76.5%) children were prescribed antibiotics irrationally, as none of
the prescriptions had been supported by blood culture and sensitivity. Some of the
operational challenges/ factors for non-adherence were lack of essential medicines
16(80%) and lack of nonfunctioning laboratories 14/20 (70%). Other challenges were
low level of knowledge of the existing guidelines 10(50%) and non-availability of
the guidelines 10(50%). 17(85%) mentioned heavy work load was as a factor to non
adherence to STGs.
Conclusions - The study found very low adherence of clinicians to standard
treatment guidelines. Only 43/149 (29%) were found to adhere to the STGs. Those
found not to adhere to the guidelines were 106(71%). The study found high irrational
use of antibiotics with 114/149(76.5% children been prescribed antibiotics without
laboratory support of blood culture and sensitivity. Similarly with antimalarial
21(14.1%) which was prescribed to children with negative mRDT. Some of the
operational challenges/ factors for non-adherence were lack of essential medicines
16(80%) and lack of functional laboratories 14/20(70%), and lack of existing
guidelines. Other challenges to adherence were low level of knowledge of the
existing guidelines and heavy work load which left no time for clinicians to consult
the STGs.
Description
A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Medicine (Paediatrics And Child Health) Of Hubert Kairuki Memorial University
Keywords
Non malaria, Children, Mwananyamala hospitals
Citation
Badya, E., 2019. Clinicians adherence to standard treatment guidelines in managing children with non-malaria febrile illnesses at Temeke and Mwananyamala Hospitals in Dar es salaam.HKMU