Research proposal sample

FACTORS CONTRIBUTING TO POOR PROGNOSIS IN PEADIATRIC COMA CASES AT ACUTE CARE UNIT MULAGO HOSPITAL

ABBREVIATION

MNRH                            –      Mulago National Referral Hospital

CM                                  –     Cerebral Malaria

ABM                               –     Acute Bacterial Meningitis

ICU                                 –      Intensive Care Unit

RPC’s                              –     Resource Poor Countries

NTC                                –      Non Traumatic Coma

GCS                                –      Glasgow Coma Scale

CNS                                 –      Central Nervous System

SID                                  –      Sudden Infant Death

UNICEF                         –      United Nations Children’s Emergency Fund

WHO                              –      World Health Organization

UMoH                             –      Uganda Ministry of Health

SUPPORT                      – Study to Understand Prognoses and Preferences of Outcome and

Risks of Treatment

A and E                           –      Accident and Emergency

CHAPTER ONE

1.0  Introduction

This chapter contains the background, problem statement, purpose of the study, specific objectives, research questions and justification of the study.

1.1Background

According to the WHO, (2017) over the past 25 years, the world has made significant progress in improving the quality of health facilities in saving young children’s lives due to this great achievement the rate of Pediatric coma cases fell by 62 per cent from 1990–2016, with pediatric mortality  rates dropping from 12.7 million to 5.6 million, the WHO report further indicates that the leading cause of global poor prognosis of peadiatric cases are preterm birth complications, pneumonia, birth asphyxia, diarrhea and malaria. On the same note UNICEF (2012). Indicates that Pediatric coma remains one of the leading cause of child death and child disability globally making 62% of the Sudden Infant Death (SID), with death occurring within 3hours following onset of coma if no urgent intervention is sought.

In Pakistan Paediatric coma has been blamed on the countries poor health facilities which has contributed to the high levels of child mortality in the country , the WHO, (2017) specifically indicates that due to poor prognosis over 420,000 children died out of the country’s total 6.3 million children in 2016.

Sub-Saharan Africa has been faced with the challenge of poor prognosis though there has been a relative decline over the years, the health sector in sub-Saharan African countries has witnessed a rise in funding over the last 20 years by development partners however there still many challenges facing the health sector this has caused poor prognosis among children in the continent for example the number of neonatal deaths remained almost the same from 1990 to 2016. Moreover, 52 countries need to accelerate progress to reach the SDG target of a neonatal mortality rate of 12 deaths per 1000 live births by 2030 (WHO, 2016).

According to Kenya demographic health survey (2016) poor prognosis has led to increase in the death among children. In 2016, child mortality rate for Kenya was 49.2 deaths per 1,000 live births. Child mortality rate of Kenya fell gradually from 159.4 deaths per 1,000 live births in 1967 to 49.2 deaths per 1,000 live births in 2016, however despite the fall the number is still high as compared to western countries in Europe (MoK, 2017). The fact attributed to poor prognosis has been mainly malaria, non communicable disease and malnourishment, in areas like Turkana over 73, 000 children are malnourished.

Paediatric coma is either traumatic or non-traumatic coma and it is a common problem in pediatric practice with high mortality and morbidity. Early recognition of the potential for catastrophic deterioration in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children (Luban, Et al, 2013).

Coma is a medical emergency which presents diagnostic as well as therapeutic challenges. The potential causes of coma are numerous, and the critical window for diagnosis and effective intervention (not only to ensure survival but also to prevent long-term squeal) is short. Pediatricians in the emergency services and intensive care units (ICU) have to frequently manage comatose patients. The incidence of non-traumatic coma is 30/100,000 children per year and that of traumatic brain injury is 670/100,000 (Ibekwe, et al, 2011).

1.2 Problem statement

Death rates as a result of paediatric coma varies from countries to countries but is more pronounced in third world countries than developed countries. There were 150,000 child death of paediatric coma in sub Saharan Africa in 2012 down from 230,000 deaths in 1990(WHO 2013).

In Uganda 2800 children every year die of paediatric coma despite the existence public health centers and hospitals where they are usually rushed. The deaths in public health facilities are much worrying as compared to private facilities like Nsambya Health care a faith based hospital in Kampala where only 17  children died of paediatric coma in 2010 (UMoH ,2012).

The documentation at acute care unit of MNRH , 1149 children are seen monthly and since April 5^th2018, 127 children were admitted to the ICU with pediatric coma, 61 children have died due to pediatric coma out of the 168 total deaths who were registered at the acute ward.

Though the government of Uganda the financial year 2015/2016, recruited an additional 3,000 health workers who included  anesthetists, medical doctors, nurses, midwives and surgeons, targeting critical cadres to offer maternal and child health, anesthetists’ services in health centers III and IV countrywide, there is still poor prognosis in peadiatric coma cases at acute care unit mulago hospital, it’s against this background that this study intends to investigate into factors leading to this poor prognosis in pediatric coma at the acute care unit in Mulago National Referral Hospital.

1.3 Study objectives

1.3.1 Broad objective

To establish the factors contributing to poor prognosis in pediatric coma cases in acute care unit at Mulago national referral hospital.

1.3.2 Specific objectives

1. To establish the socio-economic factors that contributes to the poor prognosis in pediatric coma.
2. To identify the health facility based factors contributing to poor prognosis in pediatric coma.

1.4 Research questions

1. What are the socio-economic factors contributing to poor prognosis in pediatric coma in acute unit at MNRH?
2. What is the Health facility based factors contributing in pediatric coma at the acute care unit at MNRH?

1.5 Justification of the study

The study may help in creating awareness to the readers and the nation on how to handle coma children by managing and improving on the factors which have lead to the poor prognosis of comatose children, rehabilitating some with steady progress and also decrease on the Pediatric death among the coma cases suffered by children.

The study may provide information to the future academicians on Health facility based factors contributing in pediatric coma at the acute care unit at MNRH.