Situational Analysis of Management of Childhood Diarrhea and Pneumonia in 13 District Hospitals in India

OBJECTIVE: To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India. DESIGN: Facility-based assessment of district hospitals. SETTINGS: 13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan. PARTICIPANTS: Staff nurses and doctors. INTERVENTION: None. METHODS: An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed. RESULTS: Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8–10%. There was a 65 percent shortfall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities. CONCLUSION: The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.