Dear HIFA and CHIFA colleagues,
Below are the citation, abstract and extract of a new paper in Archives of Disease in Childhood, and a comment from me.
CITATION: Jullien S, Mirsaidova M, Hotamova S, et al. Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare. Archives of Disease in Childhood 2023;108:531-537.
ABSTRACT
Background Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices.
Methods Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2–59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021.
Results Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively.
Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits.
Conclusions The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women.
EXTRACT
Unnecessary hospitalisations were common, accounting for 40.5% and 69.2% of hospitalisations in children and pregnant women, respectively. Among necessary hospitalisations, children and women were commonly kept too long when they could have safely been discharged. The misuse of antibiotics was considerable, which is of particular concern for the potential direct harm for the patients and for accelerating antimicrobial resistance, a global public health challenge.29 While antibiotics might well be indicated in children with severe pneumonia, the choice of antibiotics was not conformed to guidelines in a considerable proportion of cases. The situation is more worrying in children with diarrhoea, for which antibiotics are not indicated (except in case of dysentery) and can cause harm. Despite only one child with dysentery, 85.9% of children hospitalised with diarrhoea received antibiotics. In addition, children and women were commonly prescribed medication with no evidence of benefits.
COMMENT (NPW): It would be interesting to understand *why* children and pregnant women were being admitted unnecessarily, and why antibiotics were misused. The authors say 'While quality education and training doctors on hospitalisation criteria and management of common diseases following standards of care are surely needed, other actions are also needed for improving quality of care.'
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
