Quality of healthcare in acute paediatric care unit in a tertiary hospital in Tanzania: A case of Muhimbili National Hospital

Abstract

Background Quality of care provided in critical care unit, is vital in contributing to the outcome of critically ill children. Different studies provide mixed conclusions on the quality of care provided, and its influence on the outcomes. Little is documented especially for the case of children admitted in acute units at tertiary hospitals in Tanzania. Objective To assess the quality of healthcare in Acute Paediatric Care Unit (APCU) at Muhimbili National Hospital between July and September 2017. Methodology A case study that employed both qualitative and quantitative methods was used to gather information among the caregivers and healthcare providers over a period of three months. It involved a sample size of 107 participants who were consecutively enrolled. Readmissions within seven days of discharge and health care providers who rotated for less than two weeks All components of the Donabedian model of quality of care were assessed. Methods used in this work included observation, Key Informant Interviews, the use of semi structured questionnaires and document analysis to obtain the information required. Results These were summarized into five categories of outcome, structure, process, feedback and recommendations as guided by the Donabedian model. The participants included all caregivers whose children were >28 days and <_14 years of age admitted in APCU, 17 Healthcare providers who worked in APCU during the duration of this study and 90 Caregivers who consented. The outcome revealed majority of the children admitted, were between the ages of 1 month-4 years 68(75.6%), 46(51.1%) were males, from within Dar-es-Salaam 70(77.8%). Of the total admissions, 66 (73.3%) survived to discharge, while 24(26.7%) died within APCU. Of those who died, a significant number 10(41.7%) passed away in the first 24 hours of admission. The median age of children admitted was two years (interquartile range 58.5months) and the median duration of stay was five days, with a minimum of 4 hours and a maximum of 32 days. Most of the underlying causes of death, 17(70.8%), were infectious with septicaemia 13(76.5%) being the most common. Septic shock accounted for majority 9(60%) of the immediate causes of death. From the caregivers that consented, most reported to be VERY SATISFIED (37.8%) and SATISFIED (24.4%), collectively, with the quality of services provided. Although, a comparable number 34(37.8%) of caregivers refused to comment on this. Structure; based on observations made, the physical setting in APCU had the basic requirements for management of critically ill children but lacked in major areas in terms of infrastructure, qualified healthcare providers trained in critical care, updated treatment guidelines, had a shortage of functional emergency equipment and emergency drugs. Caregivers reported an unsupportive environment during their stay. Process; the admission process was noted to be thorough and consistent for every patient that arrived at APCU. Some setbacks were noted. Delays in the referral process and HCP training were amongst some matters that required attention.