Hospital Care for Children in Developing Countries: Clinical Guidelines and the Need for Evidence:

Trevor Duke 1,2, Julian Kelly 1, Martin Weber 3, Mike English 4 and Harry Campbell 5

  • Centre for International Child Health, Melbourne University
  • Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
  • Department of Child and Adolescent Health & Development, World Health Organization, Geneva, Switzerland
  • Kenya Medical Research Institute, Nairobi, Kenya
  • University of Edinburgh, Edinburgh, UK

Reprinted from:

Journal of Tropical Pediatrics 2006 52(1):1-2

Throughout most of the world, nurses, paramedical workers and non-specialist doctors provide the care of critically ill children who present to hospitals. While most seriously ill children in developing countries present to district and peripheral hospitals, a large proportion of hospital funding and resources is allocated to tertiary institutions. As a consequence, most critically ill children are cared for where resources are inadequate, support from central agencies is lacking, there is poor access to information, there is little ongoing professional development or staff training, and staff morale is invariably low. The quality of care provided in these hospitals has an impact on the health and lives of millions of children each year.

Until relatively recently, little attention was paid to this issue, perhaps because many children in developing countries die before reaching hospital, or due to concern that promoting hospitals might detract from primary care. Whatever the reasons, the quality of paediatric care in peripheral hospitals has been somewhat neglected by many organisations. With recent evidence that there is considerable scope for improvement [1, 2], there is a need for a serious coordinated global approach and locally appropriate interventions. Improvements in triage, diagnosis, treatment guidelines, supportive care, monitoring and follow-up would reduce hospital mortality and iatrogenic complications. These are public health as well as clinical problems; and demand approaches that can be brought to national scale [3].

In recent years the World Health Organization (WHO) has produced clinical guidelines for paediatric hospital care in developing countries. These have been developed in an attempt to provide up-to-date recommendations for management in settings that have limited resources. These guidelines include the publication: Management of the Child with a Serious Infection or Severe Malnutrition: Guidelines for Management at a District Hospital [4], and the new Pocket Book of Hospital Care for Children [5], for use by doctors and nurses in settings where resources are limited. In addition to serious infections and malnutrition, the Pocket Book also includes topics such as neonatal care, surgical problems, injuries, poisoning and others. These guidelines are an extension of IMCI, bringing these principles to the setting of a hospital of first-referral level, and focusing on the in-patient care of children seriously ill enough to be referred by IMCI primary care guidelines.