Clinicians ‘adherence to national pneumonia management guidelines among children admitted to Kitale County Hospital, Kenya

Abstract

Background: Pneumonia is the leading cause of childhood morbidity and mortality globally and in Kenya. Clinical practice guidelines for pneumonia are one of the tools advocated by WHO for reducing mortality. There are Kenyan national management guidelines adapted from WHO. Adherence to the latest guidelines has not been evaluated in Kenya. Objective: To determine adherence to national guidelines for management of pneumonia and describe hospital outcomes and associated factors among children 2-59 months discharged from Kitale County Hospital with an admission diagnosis of pneumonia. Methods: This was a retrospective chart review carried out in the Pediatric wards of Kitale County hospital in Trans Nzoia County, Kenya. Data were collected from the participant‟s inpatient records upon discharge or death. All files were included till a sample size of 380 was achieved. Data on demographics, management and outcomes was extracted from the pediatric admission form, daily ward round notes and treatment sheet. Data were then compared with the national guidelines to assess adherence. The outcomes of interest were duration of hospital stay and death. Results: The median age at recruitment was 12 months (IQR7, 24). The gender was male in 52% (198) of the participants. The diagnosis was severe pneumonia in 56% (213) and pneumonia in 44% (167) of the participants. Adherence at admission was 32 %( 121). Appropriate diagnosis was made in 53.4 %( 202), correct drug chosen in 55.8 %( 212) and correct dosage prescribed in 71.1 %( 270) of the participants. The proportion of the patients correctly managed in accordance with guidelines during the inpatient stay was 0.6 %( 2). Complete adherence from admission to discharge was in 2.1% (8) of the cases. Median length of stay was 3 days (IQR2, 4). Length of stay was not associated with age, gender, diagnosis classification, admitting clinician and nutritional status. The case fatality rate was 8.2%. Severe pneumonia (P=0.001) and overall adherence (P=<0.001) were significantly associated with mortality. On logistic regression, severe pneumonia (OR 6.365; CI 95% 1.841-22.000 P=<0.003) increased the odds of mortality. Conclusion: The level of adherence to the guidelines was low, markedly decreasing from admission to discharge. Case fatality rate was higher than global average. Recommendations: A study to evaluate factors affecting adherence to national pneumonia management guidelines and how to improve it should be carried out.