It would be interesting to know who the PHC are (midwives, nurses, health
assistant, gp, pediatrician, public health, etc.), what kind of training they had, in which setting (hospital or outpatient community based), what facilities are available if any (full blood count, urine stick, swabs, oxymeter etc ), who is supervising (Nurse, GP or Pediatrician ) and how it can be accessed (if possible) and how long the it may take, how long it takes to reach the hospital and who (gp, pediatrician, adult physician, other) is taking care of children at the hospital.
Thanks
Stefano del Torso MD
Pediatrician
EAP Executive Director
Sent by my mobile.
Please excuse typos.
CHIFA Profile: Stefano del Torso is a Primary care Pediatrician at ChildCare Worldwide ( www.ccwwitalia.org) in Italy. Professional interests: International cooperation projects. Email deltorso AT gmail.com
Il Sab 24 Giu 2023, 20:07 Neil Pakenham-Walsh <
neil.pakenham-walsh@ghi-net.org> ha scritto:
> Dear HIFA and CHIFA colleagues,
>
> Below are the citation, abstract and extract of a new paper in Archives of
> Disease in Childhood, and a comment from me.
>
> CITATION: Jullien S, Mirsaidova M, Hotamova S, et al. Unnecessary
> hospitalisations and polypharmacy practices in Tajikistan: a health system
> evaluation for strengthening primary healthcare. Archives of Disease in
> Childhood 2023;108:531-537.
>
> ABSTRACT Background Children and pregnant women require multiple contacts
> with the healthcare system. While most conditions can be managed by primary
> healthcare (PHC) providers, hospitalisations are common. This health system
> evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged
> hospitalisations and assesses antibiotic and polypharmacy practices.
>
> Methods Data were retrospectively collected from randomly selected medical
> records from 15 hospitals. Inclusion criteria were children 2–59 months of
> age with a primary diagnosis of acute respiratory infection or diarrhoea,
> or pregnant women with threatened preterm labour, threatened miscarriages,
> premature rupture of membranes or mild pre-eclampsia, hospitalised between
> January and September 2021.
>
> Results Among 440 children and 422 pregnant women, unnecessary
> hospitalisations accounted for 40.5% and 69.2% of hospitalisations,
> respectively, ranging from 0% to 92.7% across the hospitals. Among
> necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in
> children and women, respectively.
>
> Prior to admission, 36.8% of children had received antibiotics, in which
> more than half intramuscularly. During hospitalisation, 92.5% of children
> and 28.9% of women received antibiotics. Children and women received an
> average of 5 and 6.5 drugs, respectively; most were not indicated or with
> no evidence of benefits.
>
> Conclusions The methodology is applicable across all health systems and
> can provide important insights on health service use and resource waste.
> Findings of this assessment in Tajikistan have led to evidence-based
> decisions and actions from stakeholders and policy makers with the goal of
> strengthening PHC and improving the management of common diseases in
> children and pregnant women.
>
> EXTRACT Unnecessary hospitalisations were common, accounting for 40.5% and
> 69.2% of hospitalisations in children and pregnant women, respectively.
> Among necessary hospitalisations, children and women were commonly kept too
> long when they could have safely been discharged. The misuse of antibiotics
> was considerable, which is of particular concern for the potential direct
> harm for the patients and for accelerating antimicrobial resistance, a
> global public health challenge.29 While antibiotics might well be indicated
> in children with severe pneumonia, the choice of antibiotics was not
> conformed to guidelines in a considerable proportion of cases. The
> situation is more worrying in children with diarrhoea, for which
> antibiotics are not indicated (except in case of dysentery) and can cause
> harm. Despite only one child with dysentery, 85.9% of children hospitalised
> with diarrhoea received antibiotics. In addition, children and women were
> commonly prescribed medication with no evidence of benefits.
>
> COMMENT (NPW): It would be interesting to understand *why* children and
> pregnant women were being admitted unnecessarily, and why antibiotics were
> misused. The authors say 'While quality education and training doctors on
> hospitalisation criteria and management of common diseases following
> standards of care are surely needed, other actions are also needed for
> improving quality of care.'
>
> HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare
> Information For All), a global health community that brings all
> stakeholders together around the shared goal of universal access to
> reliable healthcare information. HIFA has 20,000 members in 180 countries,
> interacting in four languages and representing all parts of the global
> evidence ecosystem. HIFA is administered by Global Healthcare Information
> Network, a UK-based nonprofit in official relations with the World Health
> Organization. Email: neil@hifa.org
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