Developing training materials for health workers for the Smart Discharges Program in Uganda to decrease post-discharge mortality in children
Erin Muyres,
MSc Public, Registered Nurse with a BScN
As a McGill Master of Science in Public Health student, I completed my practicum in Kampala, the capital city of Uganda. I worked with Walimu, a Ugandan non-governmental organization that focuses on quality improvement in health care to reduce preventable deaths. As part of a grant from Grand Challenges Canada, Walimu manages the Smart Discharges program as the Ugandan implementation partner. My practicum project was a part of the Smart Discharges program.
The Smart Discharges program aims to decrease post-discharge mortality in children admitted to hospital with severe infection. They have found that the post-discharge mortality rate in these children is equivalent to, or exceeding, the in-hospital mortality rate, which is approximately five percent in each case. (1) Therefore, the time following discharge from the hospital is an incredibly vulnerable time for children who are recovering from a severe infection. In Uganda, and throughout sub-Saharan Africa, about two-thirds of all post-discharge deaths occur outside the health system, usually at home. (1) The point of discharge represents a key opportunity to ensure that vulnerable children are not lost to follow-up and are provided with the best chance of a good long-term recovery.
Smart Discharges is an approach to discharge care that uses risk prediction to identify high-risk children and aims to reduce post-discharge morbidity and mortality through improving the quality of care for children recovering from severe illnesses or infections. Vulnerable children are identified before they leave the hospital so they can be given the tools to survive after they leave the hospital.
The Smart Discharges intervention focuses on educating caregivers of all admitted children on caring for their children in the vulnerable post-discharge period including good health practices and the importance of referral and follow-up to a lower level health facility near them. Only children identified as high-risk will receive a referral for follow-up care to effectively use the limited resources available. Using the Smart Discharges approach to achieve a proper discharge and good post-discharge care has been shown to increase post-discharge care seeking by three-fold and double necessary post-discharge re-admissions. It has also shown the potential for a 30 percent reduction in mortality. (2)
My project was to help develop training materials for the Smart Discharges program. This included a two-day training for the training of health workers, administrators and caregivers on how to appropriately and effectively provide post-discharge care to children and their caregivers. The training includes learning to use a validated algorithm to assess risk to allow health workers to identify high-risk children and to target the interventions towards them. The intervention training includes how to provide targeted caregiver education for all children and follow-up care for high-risk children. These simple interventions have great potential to positively impact the post-discharge care a child receives and subsequently their survival following discharge.
This practicum provided me with beneficial and valuable experience as a public health professional in program development and implementation. It gave me an opportunity to learn in an international setting and gave me insight in how to proceed as I continue to pursue a career in global public health. It was good to have this experience as a student prior to arriving in the field as a new graduate.
About the author
Erin is a Registered Nurse with a BScN from MacEwan University in Edmonton, Alberta. Following practical experience, primarily in maternity and pediatric environments, she volunteered for two years as an RN with Mercy Ships in Benin and Madagascar. During this time she also acquired a Diploma of Tropical Nursing at the Liverpool School of Tropical Medicine in the UK. Erin is passionate about capacity building and improving health systems globally which led her to pursue a Master of Science in Public Health at McGill.
References
1. Nemetchek B, English L, Kissoon N, Ansermino JM, Moschovis PP, Kabakyenga J, et al. Pediatric postdischarge mortality in developing countries: a systematic review. BMJ Open [Internet]. 2018 Sept [cited 2019 Sept]; 8(e023445). Available from: https://bmjopen.bmj.com/content/8/12/e023445. doi:10.1136/bmjopen-2018-023445
2. Wiens MO, Kumbakumba E, Larson CP, Moschovis PP, Barigye C, Kabakyenga J, et al. Scheduled Follow-Up Referrals and Simple Prevention Kits Including Counselling to Improve Post-Discharge Outcomes Among Children in Uganda: A Proof-of-Concept Study. Global Health Science and Practice [Internet]. 2016 Sept [cited 2019 Sept];4(3):422-434. Available from: https://doi.org/10.9745/GHSP-D-16-00069. doi: 10.9745/GHSP-D-16-00069.
