A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda.

Autor: Ngabireyimana E; Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda., Mutaganzwa C; Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.; P.O. Box 3432, Kigali, Rwanda., Kirk CM; Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda., Miller AC; Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA., Wilson K; Division of General Pediatrics, Boston Children's Hospital, Boston, USA.; Harvard Medical School, Department of Global Health and Social Medicine, Boston, USA., Dushimimana E; Division of Clinical Services, Ministry of Health, Kigali, Rwanda., Bigirumwami O; Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda., Mukakabano ES; Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda., Nkikabahizi F; Rwinkwavu District Hospital, Ministry of Health, Rwinkwavu, Rwanda., Magge H; Department of Pediatrics, Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.; Division of General Pediatrics, Boston Children's Hospital, Boston, USA.
Jazyk: angličtina
Zdroj: Maternal health, neonatology and perinatology [Matern Health Neonatol Perinatol] 2017 Jul 12; Vol. 3, pp. 13. Date of Electronic Publication: 2017 Jul 12 (Print Publication: 2017).
DOI: 10.1186/s40748-017-0052-2
Abstrakt: Background: As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda.
Methods: At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014-December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher's Exact test and p -values calculated using trend analysis.
Results: 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age ( p  = 0.003), interval growth, danger sign assessment, and feeding difficulties ( p  < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time ( p  < 0.001).
Conclusions: It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.
Databáze: MEDLINE
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