Audit of management of diarrhoea among children aged 2-59 months admitted to Garissa Provincial Hospital

Abstract

Introduction: One of the ways to ensure that the quality of hospital care is maintained is the utilisation of evidence based guidelines in managing clinical conditions. Objectives: To audit and determine the adequacy of care of children aged (2-59months) with acute watery diarrhoea at Garissa Provincial Hospital. Design: A retrospective cross-sectional study. Setting: The Garissa Provincial Hospital (GPH) paediatric ward. Methodology: A total number of 376 medical records of children admitted at the GPH during the period January 2010 to June 2012 were randomly selected and evaluated against the Ministry of Health Basic Paediatric Protocols. An inventory of supplies was done by interviewing 35 health workers and by observation and filling in of an inventory checklist by the principal investigator. Results: Of the 376 children, 60.3% were male and 39.7% were female. The median age and duration of diarrhoea at presentation was 10 months (IQR 6 to 14) and 4 days (IQR 3-7) respectively. Out of the six clinical signs assessed, the most assessed sign was the level of consciousness and the least assessed sign was the capillary refill time with 48.1% and 17.6% of the patients having been assessed for it respectively. One hundred and twenty four (57.7%) were treated with antibiotics with rehydration fluid being given as prescribed by the clinician in only 15.2 % patients. Twelve (19.7%) of the patients with a diagnosis of severe dehydration did not receive intravenous fluids. Most of the items 14/17(82.35%) needed to manage acute watery diarrhoea were reported to be mostly available by more than half of the health workers. Conclusions: There was poor assessment and documentation of the general clinical signs of children by the clinicians and inappropriate use of rehydration fluid therapy and antibiotics. Recommendations: Regular in-house training with audit and regular feedback should be given to health workers.