LEADING ARTICLE

¹ Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, 3052, Victoria, Australia
² Unit for Health Services Research and International Health, Institute for Child Health IRCCS "Burlo Garofolo", Trieste, Italy

Correspondence to:
Correspondence to:
Dr T Duke, Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, 3052, Victoria, Australia;
trevor.duke@rch.org.au

Keywords: clinical management; developing countries; district hospital; quality improvement; health care

Recent observational evidence suggests there is considerable scope for improving the quality of hospital care for severely ill children in many developing countries.¹ In a study of 21 hospitals in Asia and Africa that evaluated the management of 131 children, more than half were under treated or inappropriately treated with antibiotics, fluids, feeding, or oxygen. Inadequate triage and assessment, poor treatment, and insufficient monitoring may adversely affect the outcome of a significant proportion of hospitalised children, and result in unnecessary suffering or avoidable death for many children each year. In some other settings over-hospitalisation, over-diagnosis of severe illness, and over-medication has adverse consequences for health outcomes and in wasted health expenditure.^2–4 Until recently little attention was paid to these issues; the reasons are several. Firstly, because many more children in low income countries die before reaching any hospital for want of more basic interventions, such as measles . . . [Full text of this article]

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