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Title: The first 24 hours : mortality and other outcomes of paediatric emergency care in Lagos : a case study
Author: Solebo, Colette
ISNI:       0000 0004 5360 9637
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2014
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The published research and personal practice experience from Sub-Saharan Africa indicate that up to 50% of child deaths occurring in hospital-based paediatric emergency care (PEC) take place within 24 hours of admission. This study contributes to the literature, by identifying important factors influencing mortality and other care outcomes among children admitted to a named children’s emergency room in Lagos, Nigeria (CHER) in this period of time. The study accepted the theoretical concept of a multifactorial causation of population health outcomes. Three explanatory frameworks are jointly considered in order to locate the chronological PEC pathway within a wider societal and environmental reality. A systemic review of the published literature on outcomes in developing country paediatric emergency rooms (PER), revealed that delayed progress through the PEC pathway was potentially causal of poor outcomes. Factors identified as contributing to delays included socioeconomic and cultural factors affecting parental healthcare seeking and functional features of individual PER. The literature also made a case for the role of the failures of wide-scale preventive interventions towards increasing the baseline burden for PEC in these contexts. The limitations of the previous research included the inability of the research approaches to allow an appreciation of the nature of the implicated factors and their roles relative to outcomes within the chronological PEC process. This study was conducted as a single-site case study due to the clear functional and conceptual boundaries offered by an examination of the first 24 hours in a named facility. The researcher’s social constructivist worldview emphasised the value of experiential information in examining PEC processes, as well as directing the collection analysis, and interpretation of the real-life, context-situated data. The data collection process involved 3 months of non-participant observation, 18 unstructured interviews, 4 focus groups, and the collation of 6 months’ worth of patient admission data. An inductive approach to analysis was followed by the triangulation of the emerging findings, and a final interpretation which patternmatched emergent themes against theoretical linkages towards PEC outcomes. This study identified prevailing sociocultural attitudes to illnesses in children, the use of alternative treatment modalities, public perceptions of available private care, and functional barriers in the CHER as contributing to the mortality risks and delayed progression through the in facility PEC. The study offers recommendations encouraging the public promotion of safer use of Home based self-medication HBSM, attendance at appropriate facilities, and improvements to available in-facility services, as well as the regulation of the emergency referral practice for private health providers in Lagos. It concludes by outlining the directions for the publication of the findings and suggesting possible future research.
Supervisor: Not available Sponsor: Warwick Postgraduate Research Scholarship
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General) ; RJ101 Child Health. Child health services