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Abstract
Acute gastroenteritis (GE) is a major paediatric global health problem and the second commonest cause of death in children under five accounting for an estimated 7,60,000 deaths annually worldwide. There have been significant changes to national guidelines regarding fluid management of children with dehydration secondary to GE in low resource settings. The Clinical Information Network (CIN) is operated by the Kenyan Ministry of Health, Kenyan Medical Research Institute, and Kenyan Paediatric Association (KPA). The CIN facilitates the collection of hospital data with repeated audits and feedback on clinical performance. It highlighted poor performance in assessment and management of dehydration secondary to GE.
Aim To improve the management of gastroenteritis including classification of dehydration and appropriate fluid management. Method A series of lecture and scenario based ETAT+ (Emergency Triage Assessment and Treatment plus Admission) sessions encompassing dehydration and fluid therapy secondary to diarrhoea was delivered to all cadres of staff. Management was reinforced with daily bedside teaching based on the principles of ETAT+ and KPA guidelines were displayed in admission and resuscitation areas. Feedback on clinical performance was provided daily.
Results Documentation of all key signs of dehydration had improved and 98% (from 94%) of patients had admission dehydration classified as per WHO criteria.
In children with severe dehydration aged 1–11 months correct fluid prescription increased to 85% from 45%, with 100% of patients receiving the correct fluid and duration and 85% the correct volume (from 50%). In the 12–59 month group, improvement was demonstrated in correct fluid (100% from 92.8%) duration (85.7% from 71.43%) and volume (100% from 80%) however the correct prescription remained static at 57.14%. In children classified as having no dehydration, ORS was given in 59.3% (previously 32.86%) with 100% of these being prescribed adequately (from 84.6%). A small number of parameters demonstrated deterioration including zinc prescription and classification of bloody or non-bloody diarrhoea.
Conclusion Utilising ETAT+ training has improved some important parameters in the management of GE. The data provided by the CIN is invaluable in monitoring performance and directing ongoing improvement strategies.