Zinc prescription in children with diarrhoea admitted to 22 Kenyan hospitals
Compliance to clinical guidelines has been problematic in both developed and developing countries. Case records of prescriptions have been used to assess the level of compliance in developed countries and in pharmacies. In Kenya, the health system is composed of hospitals (level 4 and 5) and health centers’. The Ministry of Health develops clinical guidelines for use in management of various conditions. For diarrhoea, only Zinc and oral rehydration salts should be used if the diarrhoea is non-bloody and addition of an antibiotic when diarrhoea is bloody. Our aim was to check the level of compliance with these guidelines, and also explore factors associated with zinc prescription.
METHODS:
This analysis is based on data from a retrospective cross-sectional survey of 22 hospitals in Kenya aimed at assessing the Quality of care conducted between June and July 2012. The proportion of pediatric diarrhoea cases (aged between 2 – 59 months) that got a zinc prescription was described. Additionally, there was exploration of various patient level characteristics which could be associated with prescription of zinc using a logistic regression model.
RESULTS:
A total of 1337 pediatric records were assessed across the hospitals, of these, 356 (26.7%) were diarrhoea cases and formed the basis of our analysis. The diarrhoea cases were similar in demographics to the other admissions. Zinc was prescribed in 64.3% (95%CI 59.1 -69.1) of these cases. Co-morbidity with malaria and pneumonia seems to lead to lower odds of zinc prescription. Being more than 6 months had higher odds of zinc prescription (OR 1.79 95%CI 1.09 – 2.95). Severity of dehydration status increased the odds of zinc prescription (OR 7.58 95%CI 1.83 – 31.38) for the most severe.
CONCLUSIONS:
Compliance with clinical guidelines for diarrhoea management is suboptimal and this is influenced by among other things, the patient characteristics which are based on the initial assessment