Assessment of quality of care for children in selected hospitals in ...

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Assessment of quality of care for children in selected hospitals in Ghanaleast one qualified nurse per shift and this was complemented with auxiliary staff; e.g. wardassistants, health‐care assistants and student nurses. Two facilities kept sick children on thefemale ward during peak seasons, and neonates in the maternity ward as their neonatal unitswere not well equipped. One facility – a newly established district hospital referred all sickneonates to the next referral level – the regional hospital. In four of the hospitals, all childrenwith surgical conditions were referred to other hospitals either because there were notheatres or no expertise to take care of them. In hospitals where paediatric surgeries wereconducted, children were either admitted to the general paediatric ward or to the adultsurgical ward.In one hospital, there was no doctor assigned to the paediatric ward; doctors had to be calledon an ad hoc basis to attend to children which poses a challenge to under‐five and paediatriccare. Assessors in one urban hospital observed that the shift system was especially weak asdoctors do not wait to hand over before leaving their shift. Most hospital OPDs close at 17:00,after which children with emergencies were admitted straight to the wards.2.2 Hospital infrastructure systemsTable1: Availability of hospital infrastructureNumber of facilitiesOPD/EmergencyWardsElectricity continuously available 8 7Backup power supply in the event of apower cut9 8Running water (pipe-borne)10 10Soap and/or disinfectant available 10 9A sharps disposal box available6 8Functioning refrigerator available for drugs 3 8Functioning refrigerator available forvaccinesInformation desk or complaints/ suggestionbox 9 1CommentsDeep wells or bore-holes wherethe national water system wasunavailable.Some of the boxes wereimprovised.Vaccines usually kept at theReproductive and Child HealthUnit of the District HealthAdministration.The nurses’ station served thepurpose of information desk onthe ward.Page 4
Assessment of quality of care for children in selected hospitals in GhanaGenerally, the support system was good.However, hospitals face power supplyinterruptions from the national grid, whichaffect the running of the emergencyarea/OPD and wards. Most of the hospitalsassessed have a backup power supply.With the exception of one hospital, most ofthe backup power was from generators.Generators were usually turned off afterabout 22:00.Veronica Bucket available in facilities that may nothave a consistent supply of running tap waterRunning water was available in the children’s ward and the emergency/OPD in all hospitals.For some hospitals, where the national water system was unavailable, water is piped in fromdeep wells or bore‐holes. Soap and disinfectants were available in the emergency areas orOPD and the children’s ward in most hospitals. There was a functioning refrigerator fordrugs in the children’s ward in most of the hospitals, but this was not common in theemergency area or OPD. These refrigerators were used to store medicines, as well as waterand food for staff in some of the hospitals.Refrigerators for vaccine storage were normally found in the Public Health unit in most ofthe hospitals and not on the children’s wards or in emergency areas or OPDs. Informationdesks were available in the emergency area or OPD, while the nurses’ station served thepurpose of information desk on the children’s ward in most of the hospitals.Hospital health statisticsThe 2009 data available from six facilities show that the total annual outpatient attendance ofchildren less than five years of age ranged from 3437 to 16748 children, for an average dailyattendance ranging from 9 to 45 in the respective facilities. Age‐specific case fatality rate(CFR) was between 1% and 2% for all age groups in under‐fives. The hospitals’ annual healthstatistics were based on the District Health Information Management System (DHIMS). TheDHIMS was not disaggregated to track children’s emergencies and neonates, as indicated inthe standards used.The top five causes of admissions and deaths in children were similar in all the hospitals andincluded malaria, anaemia, acute respiratory infections/pneumonia, diarrhoeal diseases andsepticaemia. In hospitals where surgeries were conducted, the top five most commonPage 5
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