This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Abstract Study title: Pediatric Emergency preparedness in Siaya district hospital
Introduction: The United Nations Millennium Development Goal (MDG4) number four is to
reduce the global under-five mortality rate by two-thirds between the baseline in 1990 and
2015.The under-five mortality is not declining fast enough in third world countries, the rate in
Kenya has been stagnant at128/1000 for the past 10 years.
Justification: Emergency and critical care services are often cited as one of the weakest parts of
health systems and improving such care has the potential to significantly reduce mortality.
Prevention through preparedness is probably the most important phase of response in emergency
and disaster management.
Objective: Asses’ pediatric emergency preparedness in Siaya district hospital.
Methodology: Prospective, cross-sectional study
Findings: The frequent causes of pediatric emergencies were Malaria27%, respiratory
emergencies 24%sand anemia14%. There was a shortage of essential emergency antibiotics.
Of a possible 59, 42 questionnaires were returned (Response rate 71.2%) Almost allrespondents acknowledged that they were inadequately prepared (90%). As many as 92.9%
believed that there was a protocol in their workplace for dealing with pediatric emergencies, but
only 73.9% had read these protocols. The other 7.1% did not know if there was such a protocol
or did not think there was one. If an emergency was to occur while they were at work, about two-
third (71.4%) of respondents reported that they would follow the available hospital protocol,
while another less than one-third (21.5%) would wait for instructions or direction from their
supervisors. Others would Initiate own ideas (from experience) to deal with the emergency
before the definitive action is settled upon. The majority of respondents considered that specific
course materials and activities related to pediatric emergency management should also be
developed to enable health workers to prepare for pediatric emergencies courses: First Aid
(90.4%), Basic Life Support (85.7%), and Infection Control (78.6%), Triage (66.7%). A protocol
Tableof ContentsTable of Contents .......................................................................................................................................... 5
List of tables .................................................................................................................................................. 6
Aim of the study .......................................................................................................................................... 12
Specific objectives ................................................................................................................................... 12
Map of Siaya District ................................................................................................................................... 25
Government of Kenya (GoK) health facilities comprising of one district hospital 2 sub-district
hospital 20 health centers 33 dispensaries.
Siaya district hospital (SDH) is one of the level 4 health institutions in Kenya; it has a catchment
population of 44,923 and is categorized as a low volume load district hospital. It acts as a referral
to the surrounding sub district hospitals health centers and dispensaries: It has a bed capacity of
240.Two operating rooms in the theatres. Bed occupancy ranges between 4 and 6 days. It records
an average of 16 deliveries monthly. It is a teaching hospital receiving students from Kenya
medical training college KMTC. It was recently gazzeted as an internship Centre for doctors,
clinical officers, pharmacists and nurses. The top ten causes of admission at the hospital are
Malaria, respiratory infections, skin infections, diarrheal diseases, anemia and accidents.
Pediatric emergency is an injury or illness that is acute and poses an immediate risk to a child's
life or long term health. In Siaya district hospital common causes of pediatric morbidity include:
malaria, respiratory emergencies, febrile infections, anemia and severe dehydration.
Preparedness refers to the state of being prepared for specific or unpredictable events or
situations. Preparedness is an important quality in achieving goals and in avoiding and mitigating
negative outcomes. It is a major phase of emergency management. During preparedness,
governments, organizations, and individuals develop plans to save lives, minimize delays, and
enhance emergency response. Preparedness efforts include preparedness; emergency exercises
and training; warning systems; emergency communication systems; public information and
education; and development of resource inventories; these comprise the basic emergency
equipment, drugs, fluids for resuscitation, personnel contact lists, and mutual aid agreements.
Physicians participate in preparedness and prevention in many different ways, including:
immunization programs, dietary advice, health education, and safety precautions and planning
(Esamai etal). As participants in an emergency action plan, physicians need to help formulate
ways of preventing incidents from occurring or limiting the consequences from an incident thathas already occurred. Physicians need to know what will be expected of their hospital in the case
of a potential infectious disease outbreak. They should also be prepared with the knowledge and
resources needed to help identify the etiology of a problem and to provide timely treatment.
Although we usually cannot predict emergencies, we can control them through prevention and
planning efforts. Prevention through preparedness is probably the most important phase of
response in emergency and disaster management. In an emergency preparedness study done in
Hong Kong among nurses; almost all respondents acknowledged that they were inadequately
prepared (97%). As many as 84% believed that there was a protocol in their workplace for
dealing with emergencies and disastrous events, but only 61% had read these protocols. All
participants agreed that there are courses which they should take to be prepared for these
situations. Some of these courses, in order of importance, were: First Aid (72%), Basic LifeSupport (75%), Infection Control (63%), Field Triage (58%) and others .The majority of
respondents considered that specific materials and activities related to emergency and disaster
management should also be developed to enable them to prepare for emergencies and disasters.
A protocol for emergency and disaster management was deemed necessary by 85%, pamphlets
by 84%, and drills for disaster were cited by 84% as helpful to prepare them for emergencies and
disasters.
JustificationPediatric emergencies are common occurrences’ in many health care facilities. In 2000, the
United Nations adopted the eight Millennium Development Goals (MDGs) as a focus for
international development. Goal number four is to reduce the global under-five mortality rate bytwo-thirds between the baseline in 1990 and 2015. Achieving the goal would save over six
million lives each year. There has been some progress but in 62 countries, under-five mortality is
not declining fast enough and in 27 countries the rate is stagnant (Kenya; 128/1000 over the past
10 years) or getting worse. The majority of deaths are occurring in low-income countries. Over
150 out of every 1000 children born in sub-Saharan Africa today will die before the age of five
whereas in developed countries the rate is only six per 1000. Emergency and critical care
services are often cited as one of the weakest parts of health systems and improving such care
has the potential to significantly reduce mortality(Baker2008) Introducing effective triage and
emergency treatments and establishing health care systems that prioritize the critically ill and
ensuring a reliable emergency treatment, Prevention through preparedness is probably the most
important phase of response in emergency and disaster management. Improving emergency care
units, training health staff in fundamentals of critical care concentrating on ABCs and developing
guidelines of common medical emergencies could all improve the quality of pediatric care.
Without a radical improvement in child health in low-income countries, MDG4 will not be
3.1 STUDY AREA Siaya district hospital in Karemo division Siaya district 3.2 STUDY DESIGNS Prospective, cross‐sectional study
3.2 STUDY POPULATION The study population included all health workers in the hospital clinical officers, medical
officers, nurses, counselors, and medical technicians. The total number of health workers was
118 at the time of the study, 6 doctors, 14 clinical officers, 47 nurses, 30 other health
workers. Due to limited resources and time the target was conveniently set at 59(50%) of the
population 3.4. SAMPLE SIZE ESTIMATION:
Proportional ratios according to the number of staff in a given profession. 3.5 SAMPLING METHODS AND TECHNIQUES Convenience sampling method was utilized
INCLUSION CRITERIA Health workers in Siaya district hospital working under the hospitals management.
EXCLUSION CRITERIA Health workers affiliated to non-govern mental organizations working in the hospital.
3.6 METHODS OF DATA COLLECTION Direct observation
Use of check lists: (which were adopted from the Association of American pediatricians and the
ministry of health GoK emergency tray requisites) listing basic pediatric emergency equipment
and drugs contained in the emergency tray was filled during the research period
Table 1 shows that there were a total of 203 emergency cases of these 47% were male and 53%
were female, it also shows that severe malaria 27.6% and severe respiratory emergencies 24.1%
were the most common causes of pediatric emergencies at Siaya. Severe anemia accounted for
13.8%, meningitis 5.4%, sepsis 8.3%, severe dehydration 8.9% and others 0.5%. There were 27
deaths recorded during the study period. Table 1 reveals that severe malaria was responsible for
7 (25%) of the total deaths. Total emergency related deaths accounted for 13.3% of encountered
emergencies (not shown on the table).
Facility, equipment and medication
The emergency department was the part of first building you encounter as you enter the
hospital was well labeled with a luminous white signboard facing the main gate. The department
is composed of four rooms with adequate spacing, they were in good condition; two rooms had
an emergency tray each which was constantly at work. Pediatric emergency cases are mostly
handled by the maternal and child health clinic (MCH) and the acute room in the pediatric ward
during the day, while at night all emergency cases are handled by the emergency department.
The highest staffing point in the emergency department during the day on working days is eight
while at night and on weekends is four. There is no anticipatory guidance and education given toparents regarding injury prevention and first aid, though recognition and response to febrile
illnesses is given. The waiting bay is always under direct observation and is screened frequently
by a clinical officer about four times a day. The facility hasn’t yet developed a written pediatric
emergency protocol; the facility has two ambulance and emergency hotline which are used for
response to obstetric and other emergency cases. Siaya district hospital is currently developing a
mass disaster emergency protocol. As regarding pediatric emergency and equipment, majority
are available as per the check list, there is a reliable supply of oxygen in the facility. All the
equipment is operational and well maintained. Majority of the pediatric emergency drugs were
available except for antibiotics; ceftriaxone and naloxone. There was no documentation of
emergency cases but only morbidity cases for which were entered in a specially designed
The study was carried out at the Siaya district hospital (SDH).It was explorative.
There were 203 pediatric emergency cases recorded during the study period, of these 47 %were
males and 53% were female. There were 27 deaths due to emergency related cases representing
13.3% of the encountered emergency cases. This is closely similar to the finding at the pediatric
emergency ward of Tikur Anbessa Hospital in Addis Ababa, Ethiopia which was 14.3%.The
most frequent pediatric emergency was severe malaria27.6%followed closely by respiratory
emergencies 24.1% while at Tikur Anbessa severe pneumonia was leading (44%), followed by
meningitis (8.3%) malaria was not a cause major of emergency in Ethiopia. The frequency of
severe dehydration 8.9% and sepsis 8.3% are almost similar in Ethiopia 7.9% and 7.1%
respectively. Anemia (13.8%) present as a major challenge for SDH.
There were adequate functional emergency trays with basic emergency equipment and
medication except for antibiotics which were in short supply. This was attributed to delays in
procurement procedures and high consumption of the medications in the facility.
There was a high level of unpreparedness almost all the health workers in SDH acknowledgedthat they were not prepared 90% similar to the study done in Hong Kong where 97% agreed to
not being prepared.In both studies a large number of health workers As many as 92.9% in SDH
and Hong Kong 84% believed that there was a protocol in their workplace for dealing with
pediatric emergencies, but only 73.9% had read these protocols. The other 7.1% did not know if
there was such a protocol or did not think there was one. There is statically significant difference
found .If an emergency was to occur while they were at work, about two-third (71.4%) of
respondents reported that they would follow the available hospital protocol, while another less
than one-third (21.5%) would just wait for instructions or direction from their supervisors while
in Hong Kong about a third 38.4 would use the protocol and another third 31.4% would Initiate