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

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Abstract
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].