A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda
Abstract Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implem...
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doaj-a0739ffa0a72438d92122c6e1cdccd7b2020-11-25T00:42:45ZengBMCMaternal Health, Neonatology and Perinatology2054-958X2017-07-013111110.1186/s40748-017-0052-2A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural RwandaEric Ngabireyimana0Christine Mutaganzwa1Catherine M. Kirk2Ann C. Miller3Kim Wilson4Evodia Dushimimana5Olivier Bigirumwami6Evelyne S. Mukakabano7Fulgence Nkikabahizi8Hema Magge9Rwinkwavu District Hospital, Ministry of HealthDepartment of Pediatrics, Partners In Health/Inshuti Mu BuzimaDepartment of Pediatrics, Partners In Health/Inshuti Mu BuzimaHarvard Medical School, Department of Global Health and Social MedicineDivision of General Pediatrics, Boston Children’s HospitalDivision of Clinical Services, Ministry of HealthRwinkwavu District Hospital, Ministry of HealthRwinkwavu District Hospital, Ministry of HealthRwinkwavu District Hospital, Ministry of HealthDepartment of Pediatrics, Partners In Health/Inshuti Mu BuzimaAbstract Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Methods At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis. Results 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time (p < 0.001). Conclusions It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway.http://link.springer.com/article/10.1186/s40748-017-0052-2High-risk newbornssurvivalearly childhood developmentprimary caresub-Saharan Africa |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eric Ngabireyimana Christine Mutaganzwa Catherine M. Kirk Ann C. Miller Kim Wilson Evodia Dushimimana Olivier Bigirumwami Evelyne S. Mukakabano Fulgence Nkikabahizi Hema Magge |
spellingShingle |
Eric Ngabireyimana Christine Mutaganzwa Catherine M. Kirk Ann C. Miller Kim Wilson Evodia Dushimimana Olivier Bigirumwami Evelyne S. Mukakabano Fulgence Nkikabahizi Hema Magge A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda Maternal Health, Neonatology and Perinatology High-risk newborns survival early childhood development primary care sub-Saharan Africa |
author_facet |
Eric Ngabireyimana Christine Mutaganzwa Catherine M. Kirk Ann C. Miller Kim Wilson Evodia Dushimimana Olivier Bigirumwami Evelyne S. Mukakabano Fulgence Nkikabahizi Hema Magge |
author_sort |
Eric Ngabireyimana |
title |
A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda |
title_short |
A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda |
title_full |
A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda |
title_fullStr |
A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda |
title_full_unstemmed |
A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda |
title_sort |
retrospective review of the pediatric development clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural rwanda |
publisher |
BMC |
series |
Maternal Health, Neonatology and Perinatology |
issn |
2054-958X |
publishDate |
2017-07-01 |
description |
Abstract Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Methods At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis. Results 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p < 0.001). Completion of other visit components, such as child development counseling and play/stimulation activities, were low but improved with time (p < 0.001). Conclusions It is feasible to implement PDCs with non-specialized providers in rural settings as we were able to enroll a diverse group of high-risk infants. We are seeing an improvement in services offered at PDCs over time and continuous quality improvement efforts are underway to strengthen current gaps. Future studies looking at the outcomes of the children benefiting from the PDC program are underway. |
topic |
High-risk newborns survival early childhood development primary care sub-Saharan Africa |
url |
http://link.springer.com/article/10.1186/s40748-017-0052-2 |
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