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Lessons learned from the development and implementation of an electronic paediatric emergency and acute care database in Lilongwe, Malawi
  1. Emily J Ciccone1,
  2. Alyssa E Tilly2,
  3. Msandeni Chiume3,
  4. Yamikani Mgusha3,
  5. Michelle Eckerle4,
  6. Howard Namuku5,
  7. Heather L Crouse6,
  8. Treasure B Mkaliainga3,
  9. Jeff A Robison7,
  10. Charles J Schubert8,
  11. Tisungane Mvalo9,10,
  12. Elizabeth Fitzgerald11
  1. 1Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  2. 2Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  3. 3Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
  4. 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  5. 5Department of Information Communication Technology, Kamuzu Central Hospital, Lilongwe, Malawi
  6. 6Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  7. 7Division of Pediatric Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
  8. 8Departments of Pediatrics and Family/Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  9. 9UNC Project-Malawi, Lilongwe, Malawi
  10. 10Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  11. 11Division of Emergency Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Emily J Ciccone; ciccone{at}med.unc.edu

Abstract

As the field of global child health increasingly focuses on inpatient and emergency care, there is broad recognition of the need for comprehensive, accurate data to guide decision-making at both patient and system levels. Limited financial and human resources present barriers to reliable and detailed clinical documentation at hospitals in low-and-middle-income countries (LMICs). Kamuzu Central Hospital (KCH) is a tertiary referral hospital in Malawi where the paediatric ward admits up to 3000 children per month. To improve availability of robust inpatient data, we collaboratively designed an acute care database on behalf of PACHIMAKE, a consortium of Malawi and US-based institutions formed to improve paediatric care at KCH. We assessed the existing health information systems at KCH, reviewed quality care metrics, engaged clinical providers and interviewed local stakeholders who would directly use the database or be involved in its collection. Based on the information gathered, we developed electronic forms collecting data at admission, follow-up and discharge for children admitted to the KCH paediatric wards. The forms record demographic information, basic medical history, clinical condition and pre-referral management; track diagnostic processes, including laboratory studies, imaging modalities and consults; and document the final diagnoses and disposition obtained from clinical files and corroborated through review of existing admission and death registries. Our experience with the creation of this database underscores the importance of fully assessing existing health information systems and involving all stakeholders early in the planning process to ensure meaningful and sustainable implementation.

  • health policies and all other topics
  • paediatrics
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Collaborators This work was done on behalf of the PACHIMAKE consortium.

  • Contributors EJC and AET planned and conducted the work described and drafted, revised and finalised the manuscript. MCK, YM, HN and TM planned the project, assisted with conducting the work described and revised the manuscript. ME, HLC, JAR and CJS planned the project and contributed to and revised the manuscript. TBM assisted with conducting the work described and revised the manuscript. EF supervised the project, contributed to the planning and implementation of the work described as well as the drafting and revising of the manuscript.

  • Funding The majority of the funding for this work came from donations to UNC Children’s Initiative of UNC Health Foundation, the organisation that receives philanthropic gifts to the UNC School of Medicine. This project was also in part supported by scholarships (EJC and AET) and the Global Health Scholars Program (EJC) from the UNC Office of Global Health Education. Finally, through use of REDCap, this work was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through Grant Award Number UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The survey data from the stakeholder assessments, as well as paper and/or electronic versions of the paediatric database data collection forms, are available from the corresponding author upon reasonable request.

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