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Abstract：
OBJECTIVE: This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.
METHODS: We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries.
METHODS: A total of 2796 children aged 2-23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study.
METHODS: We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations.
RESULTS: Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted.
CONCLUSIONS: Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
METHODS: We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries.
METHODS: A total of 2796 children aged 2-23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study.
METHODS: We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations.
RESULTS: Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted.
CONCLUSIONS: Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
摘要：
目的：本研究评估了低资源环境下儿童常见疾病指南不依从的患病率和相关性。
方法：我们使用了来自六个亚洲和非洲国家的八个医疗机构的二级横截面数据。
方法：2016年11月至2019年1月期间，共有2796名2-23个月的儿童因肺炎住院，腹泻或严重营养不良(SM)且无HIV感染纳入本研究.
方法：我们确定了接受全面治疗的儿童，根据特定部位的肺炎护理标准指南，部分或非粘附性初始住院护理，入院前24小时内出现腹泻和SM。使用广义估计方程确定了指南不遵守的相关性。
结果：对32%的腹泻患儿实施了全面照护，当应用严格的依从性定义时，有34％的肺炎儿童和28％的SM儿童。不遵守建议是肺炎的氧气和抗生素最常见的；液体，锌和抗生素用于腹泻；维生素A和锌用于SM。不遵守情况因网站而异。与非严重疾病患者相比，严重疾病患者更容易出现肺炎指南不依从性（OR1.82；95％CI1.38，2.34）。在较低的资产五分之一人群中，腹泻指南不遵守的可能性更大(OR1.16；95%CI1.01，1.35)，与资产较高的儿童相比，年龄较大的儿童(OR1.10;95%CI1.06,1.13)和出现消瘦的儿童(OR6.44;95%CI4.33,9.57)，年龄较小，不浪费。
结论：不遵守儿科指南是常见的，并且与年龄较大有关。疾病严重程度,和合并症，和较低的家庭经济地位。这些发现突出了通过增加具体建议的清晰度来改进指南的机会。
方法：我们使用了来自六个亚洲和非洲国家的八个医疗机构的二级横截面数据。
方法：2016年11月至2019年1月期间，共有2796名2-23个月的儿童因肺炎住院，腹泻或严重营养不良(SM)且无HIV感染纳入本研究.
方法：我们确定了接受全面治疗的儿童，根据特定部位的肺炎护理标准指南，部分或非粘附性初始住院护理，入院前24小时内出现腹泻和SM。使用广义估计方程确定了指南不遵守的相关性。
结果：对32%的腹泻患儿实施了全面照护，当应用严格的依从性定义时，有34％的肺炎儿童和28％的SM儿童。不遵守建议是肺炎的氧气和抗生素最常见的；液体，锌和抗生素用于腹泻；维生素A和锌用于SM。不遵守情况因网站而异。与非严重疾病患者相比，严重疾病患者更容易出现肺炎指南不依从性（OR1.82；95％CI1.38，2.34）。在较低的资产五分之一人群中，腹泻指南不遵守的可能性更大(OR1.16；95%CI1.01，1.35)，与资产较高的儿童相比，年龄较大的儿童(OR1.10;95%CI1.06,1.13)和出现消瘦的儿童(OR6.44;95%CI4.33,9.57)，年龄较小，不浪费。
结论：不遵守儿科指南是常见的，并且与年龄较大有关。疾病严重程度,和合并症，和较低的家庭经济地位。这些发现突出了通过增加具体建议的清晰度来改进指南的机会。
