Case management of severe XXXX --a forgotten practice: experiences from health facilities in Uganda.

@entity1 @entity4807 @entity311 @entity204 @entity413
INTRODUCTION: Severe @entity311 is a life-threatening medical emergency and requires prompt and effective treatment to prevent @entity204 . There is paucity of published information on current practices of severe @entity311 case management in sub-Saharan Africa; we evaluated the management practices for severe @entity311 in Ugandan health facilities METHODS AND FINDINGS: We did a cross sectional survey, using multi-stage sampling methods, of health facilities in 11 districts in the eastern and mid-western parts of Uganda. The study instruments were adapted from the WHO hospital care assessment tools. Between June and August 2009, 105 health facilities were surveyed and 181 health workers and 868 @entity1 /caretakers interviewed. None of the inpatient facilities had all seven components of a basic care package for the management of severe @entity311 consistently available during the 3 months prior to the survey. Referral practices were appropriate for <10% (18/196) of the @entity1 . Prompt care at any health facility was reported by 29% (247/868) of @entity1 . Severe @entity311 was correctly diagnosed in 27% of @entity1 (233).Though the @entity4807 dose and regimen was correct in the majority (611/868, 70.4%) of @entity1 , it was administered in the correct volumes of 5% @entity413 in only 18% (147/815). Most @entity1 (80.1%) had several doses of @entity4807 administered in one single 500 ml bottle of 5% dextrose. Medications were purchased by 385 (44%) @entity1 and medical supplies by 478 @entity1 (70.6%). CONCLUSIONS: Management of severe @entity311 in Ugandan health facilities was sub-optimal. These findings highlight the challenges of correctly managing severe @entity311 in resource limited settings. Priority areas for improvement include triage and emergency care, referral practises, quality of diagnosis and treatment, availability of medicines and supplies, training and support supervision.
