Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa

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dc.contributor.advisorWallis, Lee Aen_ZA
dc.contributor.advisorMaconochie, Ianen_ZA
dc.contributor.authorHansoti, Bhaktien_ZA
dc.date.accessioned2017-09-01T14:15:58Z
dc.date.available2017-09-01T14:15:58Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: Every day, sick children die from time sensitive preventable illnesses. Due to an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centres (PHC), waiting times remain high and often result in significant delays for critically ill children. Delays in the recognition of critically unwell children are a key contributing factor to avoidable childhood mortality in Cape Town, South Africa. Methodology: A stepped implementation approach was undertaken to develop and evaluate a context-appropriate prioritization tool to identify and expedite the care of critically ill children PHC in Cape Town, South Africa. Aim 1: To conduct a systematic review of paediatric triage and prioritization tools for low resource settings in order to evaluate the evidence supporting the use of these tools. Aim 2: To perform an exploratory study, to identify barriers to optimal care for critically ill children in the pre-hospital setting in Cape Town, South Africa. Aim 3: To develop an implementable context-appropriate tool to identify and expedite the care of critically ill children in PHC in the City of Cape Town, South Africa. Aim 4: Evaluate the reliability of this tool compared to established triage tools currently used in this setting. Aim 5: Evaluate the impact of implementing this tool, on waiting times for children presenting for care to PHC. Aim 6: Evaluate the effectiveness of this tool post real-world implementation in identifying and expediting the care for critically ill children. Findings: Post real world implementation SCREEN was able to significantly reduce waiting times in PHC for critically ill children. Compared to pre-SCREEN implementation, post-SCREEN the proportion of critically ill children who saw a PN within 10 minutes increased tenfold from 6.4% (pre-SCREEN) to 64% (post-SCREEN) (p<0.001). SCREEN is also able to accurately identify critically ill children, in an audit of 827 patient-charts SCREEN had a sensitivity of 94.2% and a specificity of 88.1% when compared to IMCI. Interpretation: The SCREEN program when implemented in a real-world setting has shown that it can effectively identify and expedite the care of critically ill children in PHC.en_ZA
dc.identifier.apacitationHansoti, B. (2017). <i>Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/25008en_ZA
dc.identifier.chicagocitationHansoti, Bhakti. <i>"Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2017. http://hdl.handle.net/11427/25008en_ZA
dc.identifier.citationHansoti, B. 2017. Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Hansoti, Bhakti AB - Background: Every day, sick children die from time sensitive preventable illnesses. Due to an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centres (PHC), waiting times remain high and often result in significant delays for critically ill children. Delays in the recognition of critically unwell children are a key contributing factor to avoidable childhood mortality in Cape Town, South Africa. Methodology: A stepped implementation approach was undertaken to develop and evaluate a context-appropriate prioritization tool to identify and expedite the care of critically ill children PHC in Cape Town, South Africa. Aim 1: To conduct a systematic review of paediatric triage and prioritization tools for low resource settings in order to evaluate the evidence supporting the use of these tools. Aim 2: To perform an exploratory study, to identify barriers to optimal care for critically ill children in the pre-hospital setting in Cape Town, South Africa. Aim 3: To develop an implementable context-appropriate tool to identify and expedite the care of critically ill children in PHC in the City of Cape Town, South Africa. Aim 4: Evaluate the reliability of this tool compared to established triage tools currently used in this setting. Aim 5: Evaluate the impact of implementing this tool, on waiting times for children presenting for care to PHC. Aim 6: Evaluate the effectiveness of this tool post real-world implementation in identifying and expediting the care for critically ill children. Findings: Post real world implementation SCREEN was able to significantly reduce waiting times in PHC for critically ill children. Compared to pre-SCREEN implementation, post-SCREEN the proportion of critically ill children who saw a PN within 10 minutes increased tenfold from 6.4% (pre-SCREEN) to 64% (post-SCREEN) (p<0.001). SCREEN is also able to accurately identify critically ill children, in an audit of 827 patient-charts SCREEN had a sensitivity of 94.2% and a specificity of 88.1% when compared to IMCI. Interpretation: The SCREEN program when implemented in a real-world setting has shown that it can effectively identify and expedite the care of critically ill children in PHC. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa TI - Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa UR - http://hdl.handle.net/11427/25008 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25008
dc.identifier.vancouvercitationHansoti B. Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25008en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Emergency Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherEmergency Medicineen_ZA
dc.titlePrioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africaen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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