Mortality by Admission Diagnosis in Children 1-60 Months of Age Admitted to a Tertiary Care Government Hospital in Malawi.

Diagnosis-specific mortality is a measure of pediatric healthcare quality that has been incompletely studied in sub-Saharan African hospitals. Identifying the mortality rates of multiple conditions at the same hospital may allow leaders to better target areas for intervention. In this secondary analysis of routinely collected data, we investigated hospital mortality by admission diagnosis in children aged 1-60 months admitted to a tertiary care government referral hospital in Malawi between October 2017 and June 2020. The mortality rate by diagnosis was calculated as the number of deaths among children admitted with a diagnosis divided by the number of children admitted with the same diagnosis. There were 24,452 admitted children eligible for analysis. Discharge disposition was recorded in 94.2% of patients, and 4.0% (N = 977) died in the hospital. The most frequent diagnoses among admissions and deaths were pneumonia/bronchiolitis, malaria, and sepsis. The highest mortality rates by diagnosis were found in surgical conditions (16.1%; 95% CI: 12.0-20.3), malnutrition (15.8%; 95% CI: 13.6-18.0), and congenital heart disease (14.5%; 95% CI: 9.9-19.2). Diagnoses with the highest mortality rates were alike in their need for significant human and material resources for medical care. Improving mortality in this population will require sustained capacity building in conjunction with targeted quality improvement initiatives against both common and deadly diseases.

Stretched beyond our capacity: The voices of operational managers from Ekurhuleni clinics during COVID-19.

BACKGROUND:  Operational Managers (OMs) in primary health care (PHC) experienced new management dynamics during the outbreak of coronavirus disease 2019 (COVID-19). They were not sufficiently prepared to deal with the extraordinary challenges brought by this global pandemic. OBJECTIVES:  The aim of this study was to explore and describe the PHC OMs' experiences of new management dynamics in PHC facilities, created by COVID-19 pandemic. METHOD:  This study used a qualitative, exploratory, descriptive and contextual research design and a phenomenological approach. Data were collected using in-depth semi-structured individual interviews. Data saturation was reached by the 7th interview and two more interviews were done to confirm data saturation. Data analysis was conducted using Giorgi's descriptive thematic phenomenological data analysis method. An independent coder was implored to confirm the findings. This study was guided by Rogers Diffusion of Innovation Theory. Ethical considerations were applied throughout the research process. RESULTS:  One central theme and three main themes emerged as; stretching of inadequate resources. themes; (1) budgetary cuts and increasing demands of resources, (2) insufficient of personal protective equipment, other general supplies and human resources, and (3) compromised service delivery and increased client's dissatisfaction. CONCLUSION:  This study revealed that OMs were over stretched and overwhelmed by the management on PHC facilities due to COVID-19 pandemic dynamics.Contribution: The findings of this study can be implemented in PHC facilities to effectively deal with future pandemics of such a nature.

Nurse managers experiences of their leadership roles in a specific mining primary healthcare service in the West Rand.

BACKGROUND: Nurse managers are leaders in mining primary healthcare. Their leadership roles include inspiring and empowering operational managers and nursing personnel, by leading with competence developing them to become followers with insight and direction. However, these leadership roles are not clearly defined, and are negatively influenced by the traditional mining leadership style. OBJECTIVES: The aim of this study was to explore and describe the nurse managers' experiences of their leadership roles in a specific mining primary healthcare service on the West Rand, to develop recommendations to enhance these roles. METHOD: A qualitative, exploratory, descriptive and contextual research design was used in this study, following a phenomenological approach as a research method. A non-probability purposive sampling method was used. Nurse managers described experiences of their leadership roles during individual phenomenological interviews. Data saturation was reached on participant number 7. To analyse data, four stages of Giorgi's descriptive phenomenological data analysis was used. An independent coder coded the data and a consensus meeting was held. The study was guided by the theoretical framework of Winkler's role theory. RESULTS: The following subthemes emanated from data analysis: (1) leadership role ambiguity, (2) leadership roles experienced and (3) challenges experienced in leadership roles. CONCLUSION: This study revealed that the leadership roles for nurse managers in a specific mining primary healthcare service are not clearly defined. Hence enhancements and expansions of these leadership roles remained stagnant. A clearly defined policy on leadership roles for nurse managers should be developed.