Background
Methods
Study sites and participants
Randomization and masking
Study intervention
Data collection
Performance indicators
Sample size
Statistical analysis
Results
Control | Intervention | |||
---|---|---|---|---|
Prospective | Retrospective | Prospective | Retrospective | |
Baseline (Survey 1) | ||||
Number of admission episodes included in analysis | 253 | 1005 | 252 | 1130 |
Mean (SD) age (months) | 16.2(13.3) | 15.8(12.5) | 17.0(13.3) | 15.8(12.7) |
Number (%) Male | 101(56.1) | 389(55.0) | 72(53.3) | 241(53.4) |
Number (%) of children with structured admission form in medical records | 24.0(9.5) | 30.0(3.0) | 0.0(0.0) | 0.0(0.0) |
6 month (survey 2) | ||||
Number of admission episodes included in analysis | 215 | 840 | 198 | 1022 |
Mean (SD) age (months) | 14.4(12.3) | 16.7(13.4) | 14.6(12.1) | 17.1(13.1) |
Number (%) Male | 97(50.5) | 406(54.1) | 88(56.4) | 487(56.3) |
Number (%) of children with structured admission form in medical records | 98.0(46.2) | 590.0(70.9) | 185.0(96.4) | 929.0(91.2) |
18 months (survey 4) | ||||
Number of admission episodes included in analysis | 178 | 1147 | 199 | 1158 |
Mean (SD) age (months) | 17.4(14.3) | 15.7(12.8) | 18.2(14.9) | 16.2(12.8) |
Number (%) Male | 93(58.9) | 588(53.0) | 92(51.1) | 639(58.0) |
Number (%) of children with structured admission form in medical records | 80.0(45.7) | 642.0(56.0) | 178.0(90.8) | 1112.0(96.2) |
Prospective | Retrospective | |||||||
---|---|---|---|---|---|---|---|---|
Indicator of quality of care | Intervention % | Control % | Difference [95% CI] | Risk ratio [95% CI] | Intervention % | Control % | Difference [95% CI] | Risk ratio [95% CI] |
All Children | ||||||||
Childs weight documented | 79.1 | 45 | 36.2[21.0-51.4] | 1.9[1.4-2.6] | 82.8 | 59.1 | 26.8[12.8-40.8] | 1.5[1.2-1.9] |
Child’s temperature documented | 63 | 30.5 | 30.2[−10.3-70.7] | 3.7[0.6-22.4] | 64.9 | 46 | 19.4[−14.8-53.7] | 1.9[0.6-5.8] |
Vitamin A Administered on Admission | 16.4 | 17.3 | −0.3[−8.5-7.9] | 1.2[0.7-2.0] | 22.2 | 11.9 | 10.5[−5.3-26.3] | 2.1[0.5-9.9] |
Provider Initiated HIV testing | 18.1 | 15.8 | 3.3[−10.3-16.9] | 1.3[0.5-3.2] | 16 | 3.5 | 13.0[10.1-15.9] | 5.8[2.6-12.7] |
Vaccination status documented | 41.3 | 18.6 | 23.9[6.0-41.7] | 3.1[0.9-10.0] | 50.8 | 27.2 | 26.9[9.9-44.0] | 2.6[1.2-5.6] |
Average assessment score (range, 0–1) | 92.1 | 58.7 | 50.1[23.9-76.3] | 92.6 | 67.2 | 49.9[30.5-69.2] | ||
Children with diagnosis of malaria | ||||||||
Proportion of malaria with a severity classification | 91.9 | 43 | 50.9[23.7-78.0] | 2.4[1.3-4.4] | 89.1 | 46.8 | 41.4[14.3-68.5] | 2.0[1.1-3.5] |
Proportion with quinine loading dose | 88.5 | 59.3 | 46.4[5.9-86.8] | 2.5[0.9-7.1] | 86.9 | 58.1 | 37.6[9.0-66.2] | 2.0[1.0-3.8] |
Proportion with twice daily quinine maintenance dose | 94.1 | 74.9 | 24.7[11.4-38.1] | 1.4[1.1-1.7] | 79 | 42.5 | 37.5[14.2-60.7] | 1.9[1.3-2.8] |
Proportion with quinine daily dose > =40 mg/kg | 4 | 1 | 3.0[−1.4-7.4] | 2.2 | 8 | −7.0[−13.4--0.5] | 0.2[0.1-0.6] | |
Children with diagnosis of pneumonia | ||||||||
Proportion of pneumonia with a severity classification | 95.8 | 63.6 | 46.8[−1.2-94.8] | 1.5[1.1-2.0] | 93.3 | 70.1 | 33.5[−2.7-69.7] | 1.7[0.9-3.1] |
Proportion with once daily gentamicin dose | 86.8 | 57.6 | 27.6[11.6-43.5] | 1.5[1.1-2.1] | 79.1 | 68.1 | 14.9[9.7-20.1] | 1.2[1.1-1.4] |
Proportion with gentamicin daily dose <4 mg/kg | 3.9 | 3.4 | 2.3[−3.3-7.9] | 1.9[0.8-4.3] | 3.9 | 15.3 | −10.2[−12.3--8.1] | 0.3[0.2-0.4] |
Proportion with gentamicin daily dose > =10 mg/kg | 4.7 | 6.8 | −0.4[−6.0-5.2] | 1.0[0.5-2.2] | 8.6 | 9.9 | −0.3[−3.1-2.5] | 1.0[0.7-1.4] |
Children with diagnosis of diarrhea/dehydration | ||||||||
Proportion of diarrhoea/dehydration diagnosis with a severity classification | 98.6 | 85.2 | 8.2[−16.3-32.8] | 1.1[0.8-1.5] | 97.9 | 89.1 | 14.7[2.9-26.5] | 1.2[1.0-1.4] |
Correct fluid prescription | 67.3 | 11.5 | 60.2[23.5-96.9] | 2.7[1.4-5.3] | 62.2 | 32.7 | 33.0[22.8-43.2] | 2.1[1.6-2.9] |
Prospective | Retrospective | |||||||
---|---|---|---|---|---|---|---|---|
Indicator of quality of care | Intervention % | Control % | Difference [95% CI] | Risk ratio [95% CI] | Intervention | Control | Difference [95% CI] | Risk ratio [95% CI] |
All Children | ||||||||
Childs weight documented | 79.1 | 45 | 34.1[27.7-40.4] | 1.8[1.6-2.0] | 82.8 | 59.1 | 23.7[21.0-26.4] | 1.4[1.3-1.5] |
Child’s temperature documented | 63 | 30.5 | 32.4[25.9-39.0] | 2.1[1.7-2.4] | 64.9 | 46 | 18.9[15.9-21.8] | 1.4[1.3-1.5] |
Vitamin A Administered on Admission | 16.4 | 17.3 | −0.9[−6.1-4.3] | 0.9[0.7-1.3] | 22.2 | 11.9 | 10.3[8.0-12.5] | 1.9[1.6-2.1] |
Provider Initiated HIV testing | 18.1 | 15.8 | 2.3[−2.9-7.6] | 1.1[0.8-1.6] | 16 | 3.5 | 12.6[10.8-14.3] | 4.6[3.6-6.0] |
Vaccination status documented | 41.3 | 18.6 | 22.7[16.6-28.9] | 2.2[1.8-2.8] | 50.8 | 27.2 | 23.6[20.8-26.5] | 1.9[1.7-2.0] |
Average assessment score (range, 0–1) | 92.1 | 58.7 | 33.4[29.9-36.9] | 92.6 | 67.2 | 25.4[23.9-26.9] | ||
Children with diagnosis of malaria | ||||||||
Proportion of malaria with a severity classification | 91.9 | 43 | 48.9[42.1-55.7] | 2.1[1.9-2.5] | 89.1 | 46.8 | 42.3[39.1-45.5] | 1.9[1.8-2.0] |
Proportion with quinine loading dose | 88.5 | 59.3 | 29.2[20.5-37.9] | 1.5[1.3-1.7] | 86.9 | 58.1 | 28.8[24.8-32.8] | 1.5[1.4-1.6] |
Proportion with twice daily quinine maintenance dose | 94.1 | 74.9 | 19.2[12.2-26.2] | 1.3[1.1-1.4] | 79 | 42.5 | 36.5[32.0-41.1] | 1.9[1.7-2.0] |
Proportion with quinine daily dose > =40 mg/kg | 4 | 1 | 2.9[−0.1-6.0] | 3.8[0.8-17.6] | 2.2 | 8 | −5.8[−8.0--3.6] | 0.3[0.2-0.4] |
Children with diagnosis of pneumonia | ||||||||
Proportion of pneumonia with a severity classification | 95.8 | 63.6 | 32.2[24.0-40.4] | 1.5[1.3-1.7] | 93.3 | 70.1 | 23.2[19.9-26.6] | 1.3[1.3-1.4] |
Proportion with once daily gentamicin dose | 86.8 | 57.6 | 29.2[19.9-38.5] | 1.5[1.3-1.7] | 79.1 | 68.1 | 11.1[6.7-15.4] | 1.2[1.1-1.2] |
Proportion with gentamicin daily dose <4 mg/kg | 3.9 | 3.4 | 0.5[−3.8-4.8] | 1.1[0.4-3.7] | 3.9 | 15.3 | −11.4[−14.3--8.6] | 0.3[0.2-0.4] |
Proportion with gentamicin daily dose > =10 mg/kg | 4.7 | 6.8 | −2.1[−7.3-3.1] | 0.7[0.3-1.8] | 8.6 | 9.9 | −1.2[−4.1-1.6] | 0.9[0.6-1.2] |
Children with diagnosis of diarrhea/dehydration | ||||||||
Proportion of diarrhoea/dehydration diagnosis with a severity classification | 98.6 | 85.2 | 13.4[3.6-23.3] | 1.2[1.0-1.3] | 97.9 | 89.1 | 8.7[5.9-11.6] | 1.1[1.1-1.1] |
Correct fluid prescription | 67.3 | 11.5 | 55.8[37.8-73.8] | 5.8[2.0-17.2] | 62.2 | 32.7 | 29.5[22.9-36.1] | 1.9[1.6-2.2] |
Prospective | Retrospective | |||||
---|---|---|---|---|---|---|
Indicator | Baseline OR | Post intervention OR | Ratio of OR | Baseline OR | Post intervention OR | Ratio of OR |
All Children | ||||||
Childs weight documented | 3.95(1.92-8.15) | 4.99(2.51-9.94) | 1.26(0.76-2.10) | 9.32(3.28-26.46) | 4.06(1.45-11.39) | 0.44(0.33-0.57) |
Child’s temperature documented | 0.68(0.07-6.23) | 4.09(0.46-36.08) | 5.99(3.10-11.57) | 0.81(0.09-7.34) | 1.75(0.20-15.59) | 2.15(1.53-3.03) |
Vitamin A Administered on Admission | 0.23(0.06-0.93) | 1.18(0.40-3.53) | 5.08(1.87-13.84) | 0.32(0.07-1.55) | 2.44(0.53-11.29) | 7.61(4.93-11.75) |
Provider Initiated HIV testing | 13.08(2.63-65.14) | 1.21(0.56-2.61) | 0.09(0.02-0.42) | 2.24(0.97-5.18) | 5.65(3.57-8.93) | 2.52(1.14-5.57) |
Vaccination status documented | 0.08(0.02-0.38) | 4.56(1.22-17.09) | 56.29(22.06-143.58) | 0.23(0.06-0.81) | 4.38(1.24-15.43) | 19.42(14.07-26.81) |
Average assessment score (range, 0–1) | Mean = −0.04(−0.17-0.09) | Mean = 0.33(0.20-0.45) | Differences in Means = 0.37(0.32-0.41) | Mean = 0.01(−0.10-0.12) | Mean = 0.27(0.16-0.38) | Differences in Means = 0.26(0.24-0.28) |
Children with diagnosis of malaria | ||||||
Proportion of malaria with a severity classification | 2.92(0.95-8.96) | 15.28(5.80-40.27) | 5.22(2.05-13.31) | 6.10(2.35-15.85) | 8.80(4.01-19.28) | 1.44(0.77-2.69) |
Proportion with quinine loading dose | 5.72(0.95-34.50) | 7.38(2.22-24.61) | 1.29(0.28-5.97) | 0.41(0.14-1.19) | 6.63(2.47-17.76) | 16.24(9.28-28.41) |
Proportion with twice daily quinine maintenance dose | 4.37(1.07-17.89) | 5.68(2.30-14.03) | 1.30(0.31-5.48) | 0.05(0.01-0.24) | 6.45(2.23-18.65) | 131.29(37.51-459.47) |
Proportion with quinine daily dose > =40 mg/kg | 2.68(0.16-44.63) | 3.25(0.21-49.51) | 1.21(0.09-16.85) | 1.45(0.77-2.71) | 0.50(0.24-1.02) | 0.35(0.17-0.68) |
Children with diagnosis of pneumonia | ||||||
Proportion of pneumonia with a severity classification | 2.00(0.34-11.71) | 23.33(3.93-138.58) | 11.68(3.40-40.07) | 1.72(0.59-4.99) | 7.29(2.70-19.66) | 4.24(2.40-7.48) |
Proportion with once daily gentamicin dose | 0.65(0.11-3.93) | 6.09(1.05-35.31) | 9.34(3.05-28.57) | 0.29(0.11-0.76) | 1.81(0.95-3.43) | 6.24(2.78-14.02) |
Proportion with gentamicin daily dose <4 mg/kg | 2.76(0.60-12.67) | 1.38(0.26-7.48) | 0.50(0.10-2.63) | 2.20(1.18-4.10) | 0.21(0.11-0.41) | 0.09(0.05-0.16) |
Proportion with gentamicin daily dose > =10 mg/kg | 1.54(0.28-8.55) | 0.67(0.24-1.84) | 0.44(0.06-3.19) | 0.44(0.24-0.81) | 0.90(0.59-1.38) | 2.07(1.07-4.00) |
Children with diagnosis of diarrhea/dehydration | ||||||
Proportion of diarrhoea/dehydration diagnosis with a severity classification | 0.23(0.03-1.59) | 12.80(1.42-115.47) | 55.99(3.03-1034.44) | 0.78(0.47-1.28) | 5.85(3.07-11.17) | 7.53(3.63-15.62) |
Correct fluid prescription | 3.9e + 06(0.00- .) | 15.81(4.13-60.59) | 0.00(0.00- .) | 0.18(0.06-0.59) | 3.57(1.72-7.42) | 19.56(7.04-54.40) |