Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital – mixed methods research

Irimu, Grace W; Greene, Alexandra; Gathara, David; Kihara, Harrison; Maina, Christopher; Mbori-Ngacha, Dorothy; Zurovac, Dejan; Santau, Migiro; Todd, Jim; English, Mike

doi:10.1186/1472-6963-14-119

Table 1 Definition of the composite indicators of processes of care for each disease (doi:10.1371/journal.pone.0039964.t001.)

From: Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital – mixed methods research

Domain of care	Criteria for considering the composite indicator achieved	Pneumonia	Dehydration	Severe malnutrition
Assessment	Patient adequately assessed if all the following signs are assessed	Level of consciousness ability to drink^a, cyanosis, lower chest wall indrawing and respiratory rate	Level of consciousness, pulse character^b, ability to drink^a, sunken eyes and skin turgor (and duration of skin fold to return)	Oedema, and weight for height Z-score or visual assessment of degree of severe wasting
Classification	Consistent with CPGs/ETAT + if any the corresponding terms are used	Very severe pneumonia, severe pneumonia,	Shock, severe dehydration, some dehydration and no dehydration	Severe malnutrition, oedematous malnutrition, protein energy malnutrition, marasmic kwashiorkor, kwashiorkor marasmus
Treatment	Consistent with CPGs if the following key treatment was prescribed at the correct dose and frequency (and duration for rehydration therapy)	Crystalline penicillin 50,000 units/kg/dose × 4 per day (+/-20%) and/or Gentamicin 7.5 mg/kg/day × 1 per day (+/-20%)	Hartman’s solution^c at 80–120 mls per kg if not given bolus for shock management or 56–120 mls per kg if given bolus for shock management given over 5–6 hours for patients ages 2–11 months and 2.5-3 hours in patients aged 12–59 months	100-130 mls/kg/day (+/-20%) of F75^d
Follow-up care	Consistent with WHO/Kenya guidelines as adapted by the hospital staff	Evidence that doses of Crystalline penicillin were given as prescribed in the first 48 hrs of admission^e	Evidence that intravenous fluid (IV) therapy for severe dehydration was monitored	Evidence that intake of feeds for severe malnutrition was monitored^e

^aPatients documented to have altered consciousness were assumed that they are not able to drink if ability to drink is not documented while patients documented in the history as able to drink were assumed to have the sign ‘able to drink’.
^bPatients documented as able to drink or alert were assumed not to have a weak pulse if pulse character was not documented.
^cIf dextrose added, correct if given at 2.4-6.0 mg/kg/min (approximates dextrose requirement for a sick child 3-5 mg/kg/min; +/-20%).
^dWas either a manufactured product (depending on the availability) or milk-based solution prepared in the hospital that provided 75 kcal and 0.9 g of protein/100 ml.
^eInitial treatment is considered given on time if it is given within 12 hours of admission on the ward.

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