PP044 Topic: AS04–Emerging Sciences, Methodologies, Big Data and Technology: MONITORING CRITICALLY ILL CHILDREN IN MALAWI: A QUALITATIVE STUDY

Pediatric Critical Care Medicine, vol. 25, pp. e34

Abstract

Aims & Objectives: Critically ill children require close monitoring to facilitate timely interventions throughout their hospital admission. In low- and middle-income countries, effective monitoring is complicated by a high disease burden yet scarce pediatric critical care resources. This study aims to describe the monitoring practices for critically ill children and examines factors affecting monitoring in a pediatric high-dependency unit (HDU) in Malawi. Methods: An exploratory qualitative study based on 21 in-depth interviews with healthcare workers (n=12) working in the high dependency unit and caregivers of critically ill children (n=9), and on structured observation of monitoring. Interviews were transcribed and translated for thematic content analysis. Results: The ward layout, power outages, a lack of human resources, and limited familiarity with the available monitoring devices affected the monitoring of critically ill children admitted to the high-dependency unit. Monitoring was mostly performed intermittently, through clinical observations. Healthcare workers prioritized the sickest children for more frequent or continuous monitoring using the available devices. Caregivers, usually present throughout admission, were involved informally in flagging possible deterioration to healthcare staff. Conclusions: Opportunities to improve the monitoring of critically ill children in high-dependency units include ongoing training of healthcare workers to effectively allocate and employ the available devices, and/or supporting caregivers to play a more formal role in escalation. In lower-resource critical care settings, healthcare staff need support to allocate effectively the available resources for monitoring admitted children. In the absence of adequate devices, this includes training and support for prioritization of the most ill. Keywords: critically ill children, Qualitative research, Monitoring

Authors 8

1. Daniel Mwale

   Amsterdam University Medical Centers · Kamuzu University of Health Sciences · University of Amsterdam

   Affiliation as printed

   Department of Global Health, Amsterdam UMC, University of Amsterdam, Netherlands

   Kamuzu University of Health Sciences, Blantyre, Malawi

2. Lucinda Manda‐Taylor

   Kamuzu University of Health Sciences

   Affiliation as printed

   Kamuzu University of Health Sciences, Health Systems and Policy, Blantyre, Malawi

3. Alice Likumbo
   Affiliation as printed

   Training Research Unit of Excellence, Blantyre, Malawi

4. Michaël Boele van Hensbroek

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Global Health, Amsterdam UMC, University of Amsterdam, Netherlands

5. Job C. J. Calis

   Amsterdam University Medical Centers

   Affiliation as printed

   Amsterdam Centre for Global Child Health, Amsterdam UMC, Netherlands

6. IMPALA Study Team

   Kamuzu University of Health Sciences

   Affiliation as printed

   Kamuzu University of Health Sciences, Blantyre, Malawi

7. Wendy Janssens

   Vrije Universiteit Amsterdam

   Affiliation as printed

   Vrije Universiteit Amsterdam, Netherlands

8. Margot M. Rakers Aachen Public Health and Primary Care Department

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands