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BMJ. 2007 Oct 27;335(7625):862. Epub 2007 Oct 22.

Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial.

Author information

1
Projecto de Sa├║de de Bandim, INDEPTH Network, Bissau Codex 1004, Guinea-Bissau. sidubiai@hotmail.com

Abstract

OBJECTIVE:

To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality.

DESIGN:

Randomised controlled intervention trial.

SETTING:

Paediatric ward at the national hospital in Guinea-Bissau. All children admitted to hospital with severe malaria received free drug kits.

PARTICIPANTS:

951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards.

INTERVENTIONS:

Before the start of the study, all personnel were trained in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros)/month for nurses and $160 for doctors) and their compliance with standard case management was closely monitored.

MAIN OUTCOME MEASURES:

In-hospital mortality and cumulative mortality within 4 weeks of hospital admission.

RESULTS:

In-hospital mortality was 5% for the intervention group and 10% in the control group (risk ratio 0.48, 95% confidence interval 0.29 to 0.79). The effect may have been stronger in patients with positive malaria slides (0.36, 0.16 to 0.80). Cumulative mortality 4 weeks after discharge was also lower in the intervention group (0.61, 0.40 to 0.95).

CONCLUSIONS:

Supervising healthcare workers to adhere to a standardised treatment protocol was associated with greatly reduced in-hospital mortality. Financial incentives may be important for the dedication and compliance of staff members.

TRIAL REGISTRATION:

Clinical Trials NCT00465777 [ClinicalTrials.gov].

PMID:
17954513
PMCID:
PMC2043445
DOI:
10.1136/bmj.39345.467813.80
[Indexed for MEDLINE]
Free PMC Article
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