Piloting a pragmatic clinical audit tool for quality improvement in rural paediatric care in northern Sierra Leone

Hospital admissions and their clinical outcomes can reflect the disease burden in a population and can be utilised as effective surveillance and impact monitoring tools. Inadequate documentation of admissions and their outcomes have contributed to the poor quality of paediatric care in many health care settings in sub-Saharan Africa. We have developed and piloted a simple tool for documentation of basic, standardised patient-level information on causes of admissions, diagnoses, treatments and outcomes in patients admitted to the paediatric ward of a district hospital in a rural community in Sierra Leone. From 1 August 2019 to 31 July 2021, we used this tool to document the admissions, treatments and clinical outcomes of 1,663 children admitted to this hospital. The majority of the children (1015, 62%) were aged between 12-59 months, were boys (942, 57%), were wasted (516, 31%), stunted (238 14%) or underweight (537, 32%). More than half of the children lived more than 1 km distance from the hospital (876/1410, 62%). Most were admitted before 4pm (1171/1626, 72%) and during weekdays (1231/1662, 74%). The highest number of paediatric admissions occurred in November 2019 and the lowest in April 2020. Severe malaria was the leading cause of admission. More than 80% of the children were successfully treated and discharged home (1356/1663, 81.5%) while 122/1663 (7.3%) died. Children aged under-five years who were underweight, and those who presented with danger signs (e.g. signs of breathing difficulty, dehydration, head injury or severe infections) had a higher risk of death than children without these features (p<0.01; p=0.03; p=0.011 and p= 0.009, respectively). Lack of systematic documentation of medical histories and poor record keeping of hospital admissions and outcomes can be overcome by using a simple tool. Continuous use of the tool with regular audits could improve delivery of paediatric care in resource-limited settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the EBOVAC-Salone project which was sponsored by Janssen Vaccines & Prevention BV. This project received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 800176. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Association. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approvals for the study were obtained from the Research Ethics Committee of the London School of Hygiene & Tropical Medicine and the Sierra Leone Ethics and Scientific Review Committee. Written permission for the study was obtained from the Management of the Kambia Government Hospital, an arm of the Sierra Leone Ministry of Health and Sanitation. Written informed consent was obtained from the parents/care-givers before the tool was used to collect their child’s health information. In addition, assent was obtained from children aged seven years and above. Personal data collected about the hospitalised children were anonymised, kept confidential and held in compliance with international data privacy protection laws and regulations. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data for this study are accessible on Dryad: . .