Comparing hospital-based quality of care for children with sickle cell crisis in northern Malawi

Abstract

Background: Sickle Cell Disease (SCD) affects millions of people globally. It carries a high mortality of 50% - 90%. In Malawi it contributes a significant proportion of (3.1%) of paediatric hospitalisations demanding quality care. The most serious acute complication of SCD is Sickle Cell Crisis (SCC). Little is known on the quality of care given to children with SCC. Aim of the study: To compare the quality of care provided to hospitalised children in Sickle Cell Crisis in selected hospitals in Northern Malawi thus Mzuzu Central, Rumphi District and Ekwendeni Hospitals. Methodology: A quantitative approach employing a descriptive cross-sectional design was used. Data was collected from Nurses, Doctors and Clinical Officers working in paediatric wards and files of children who were hospitalised due to SCC between 2019 and 2021 using probability sampling. The sample sizes of 87, 28, and 9 for case file review and 36, 11, and 6 for health care workers were used, respectively, at a 95% confidence level. Data was collected using a self-administered questionnaire and the checklist. Statistical Package for Social Sciences (SPSS) version 26 was used to analyse data focusing on descriptive and inferential statistics. Mzuzu University Research Ethical Committee approved the study (MZUNIREC/DOR/23/14), and permission was obtained from study sites. Results: The results indicated high availability of resources for managing SCC across all hospitals. However, a significant proportion of children did not receive oxygen therapy as part of their management, with 100% (n=9) at Mission, 82.1% (n=23) at District, and 56.3% (n=49) at Central Hospitals. Most children did not receive the correct amounts of fluids as per the guidelines. The absence of standardized guidelines was a significant challenge (p = 0.042). Conclusion: Lack of accessibility to guidelines, pain assessment tools and shortage of staff affect the delivery of quality care in hospitals in Northern Malawi.