Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria

randomised trial

Sidu Biai, Amabelia Rodrigues, Melba Gomes, Isabela Ribeiro, Morten Sodemann, Fernanda Alves, Peter Aaby

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Udgivelsesdato: Oct-27
OriginalsprogEngelsk
TidsskriftBMJ. British Medical Journal (International Ed.)
Vol/bind335
Udgave nummer7625
Sider (fra-til)862
ISSN0959-8146
DOI
StatusUdgivet - 27. okt. 2007

Fingeraftryk

Hospital Mortality
Malaria
Guinea-Bissau
Nurses
Case Management
Randomized Controlled Trials
Odds Ratio
Clinical Trials
Guidelines
Confidence Intervals
Pediatrics
Delivery of Health Care
Control Groups
Health
Pharmaceutical Preparations

Citer dette

Biai, Sidu ; Rodrigues, Amabelia ; Gomes, Melba ; Ribeiro, Isabela ; Sodemann, Morten ; Alves, Fernanda ; Aaby, Peter. / Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria : randomised trial. I: BMJ. British Medical Journal (International Ed.). 2007 ; Bind 335, Nr. 7625. s. 862.
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title = "Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial",
abstract = "OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros)/month for nurses and $160 for doctors) and their compliance with standard case management was closely monitored. MAIN OUTCOME MEASURES: In-hospital mortality and cumulative mortality within 4 weeks of hospital admission. RESULTS: In-hospital mortality was 5{\%} for the intervention group and 10{\%} in the control group (risk ratio 0.48, 95{\%} confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95). CONCLUSIONS: Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospital mortality. Financial incentives may be important for the dedication and compliance of staff members. TRIAL REGISTRATION: Clinical Trials NCT00465777 [ClinicalTrials.gov].",
keywords = "Child, Preschool, Guinea-Bissau, Hospital Mortality, Humans, Infant, Length of Stay, Malaria, Treatment Outcome",
author = "Sidu Biai and Amabelia Rodrigues and Melba Gomes and Isabela Ribeiro and Morten Sodemann and Fernanda Alves and Peter Aaby",
year = "2007",
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doi = "10.1136/bmj.39345.467813.80",
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volume = "335",
pages = "862",
journal = "B M J",
issn = "0959-8146",
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Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria : randomised trial. / Biai, Sidu; Rodrigues, Amabelia; Gomes, Melba; Ribeiro, Isabela; Sodemann, Morten; Alves, Fernanda; Aaby, Peter.

I: BMJ. British Medical Journal (International Ed.), Bind 335, Nr. 7625, 27.10.2007, s. 862.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria

T2 - randomised trial

AU - Biai, Sidu

AU - Rodrigues, Amabelia

AU - Gomes, Melba

AU - Ribeiro, Isabela

AU - Sodemann, Morten

AU - Alves, Fernanda

AU - Aaby, Peter

PY - 2007/10/27

Y1 - 2007/10/27

N2 - OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros)/month for nurses and $160 for doctors) and their compliance with standard case management was closely monitored. MAIN OUTCOME MEASURES: In-hospital mortality and cumulative mortality within 4 weeks of hospital admission. RESULTS: In-hospital mortality was 5% for the intervention group and 10% in the control group (risk ratio 0.48, 95% confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95). CONCLUSIONS: Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospital mortality. Financial incentives may be important for the dedication and compliance of staff members. TRIAL REGISTRATION: Clinical Trials NCT00465777 [ClinicalTrials.gov].

AB - OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros)/month for nurses and $160 for doctors) and their compliance with standard case management was closely monitored. MAIN OUTCOME MEASURES: In-hospital mortality and cumulative mortality within 4 weeks of hospital admission. RESULTS: In-hospital mortality was 5% for the intervention group and 10% in the control group (risk ratio 0.48, 95% confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95). CONCLUSIONS: Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospital mortality. Financial incentives may be important for the dedication and compliance of staff members. TRIAL REGISTRATION: Clinical Trials NCT00465777 [ClinicalTrials.gov].

KW - Child, Preschool

KW - Guinea-Bissau

KW - Hospital Mortality

KW - Humans

KW - Infant

KW - Length of Stay

KW - Malaria

KW - Treatment Outcome

U2 - 10.1136/bmj.39345.467813.80

DO - 10.1136/bmj.39345.467813.80

M3 - Journal article

VL - 335

SP - 862

JO - B M J

JF - B M J

SN - 0959-8146

IS - 7625

ER -