P3.I163: ICATCH Program-Improve nurses’ knowledge toward danger signs recognition, and transfer management in pediatric illnesses in Nyanza district-Rwanda

Background: Nyanza District Hospital is one of 44 district hospitals in Rwanda, and it serves about 320,000 populations and monthly admits about 120-140 sick children and almost all are transferred from its 17 health Centers that are run by nurses and midwives.
Among the total admissions, about 40% of the children came in critical status including but not limited to severe dehydration, hypovolemic shock, severe hypoxemia and/or severe malnutrition. Most of these children who come in critical status are transferred after the initial 2-3 times consultation and/or admission at the health centers due to inadequate pre-transfer triage, or lack of knowledge to recognize a sick child requiring the transfer.

Aim: The aim is to improve danger signs recognition, pre-referral management and early transfer of critically ill children, consequently reducing their mortality and morbidity.

Methods: This is an ongoing ICATCH project and is being achieved through a training of nurses about danger signs recognition and pre-referral management followed by a mentorship program dedicated to nurses working in 10 health centers with the highest number of transfers of critical children. A team of 4 medical officers and one pediatrician oversees this mentorship and each selected health center is visited every month for two consecutive days. The mentorship is conducted using Emergency Triage, Assessment and Treatment plus (ETAT+) protocol with focus on practical sessions to recognize danger signs, signs of disease progression and pre-transfer management. Baseline data as well as data after training about the status illness of children coming from selected health centers at admission have been collected.

Results: Immediately after nurse training, participants' knowledge of danger signs recognition improved from 69.6% to 80.4% average score on detecting a critically ill child requiring the transfer, identifying a chronic illness requiring special care and the right pre-referral management.
The outcome of the acquired knowledge by trained nurses, a total of 205 records of children in pre-project have been done as baseline before the training and 257 records of children coming from selected health centers have been registered within the period of six months after training. The majority were males 68.6%, the median age is 21 months. The children received within this period were having dehydration 40.2% while 48.9% were having respiratory distress however the number of children arriving in critical status have decreased from 37.5% to 31.2%.

Conclusion: Nurses training about early recognition of danger signs using ETAT+ protocol and continuous mentorship are crucial in reducing delay in transfer of children in need and improving pre-referral management, hence reducing morbidity.