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INTRODUCTION: The provision of high-quality care is vital to improve child health and survival rates. A simple, practice-based tool was recently developed to evaluate the quality of paediatric emergency care in resource-limited settings in Africa. This study used the practice-based tool to describe the documented adherence to critical actions in paediatric emergency care at an urban district-level hospital in South Africa and assess its relation to clinical outcomes. METHODS: This study is a retrospective observational study covering a 19-month period (September 2017 to March 2019). Patients <13 years old, presenting to the emergency centre with one of six sentinel presentations (seizure, altered mental status, diarrhoea, fever, respiratory distress and polytrauma) were eligible for inclusion. In the patients' files, critical actions specific for each presentation were checked for completion. Post-hoc, a seventh group 'multiple diagnoses' was created for patients with more than one sentinel disease. The action completion rate was tested for association with clinical outcomes. RESULTS: In total, 388 patients were included (median age 1.1 years, IQR 0.3-3.6). The action completion rate varied from 63% (polytrauma) to 90% (respiratory distress). Participants with ≥75% action completion rate were younger (p < 0.001), presented with high acuity (p < 0.001), were more likely to be admitted (adjusted OR 2.2, 95%CI: 1.2-4.1), and had a hospital stay ≥4 days (adjusted OR 3.4, 95%CI: 1.5-7.9). CONCLUSION: A high completion rate was associated with young age, a high patient acuity, hospital admission, length of hospital stay ≥4 days, and the specific sentinel presentation. Future research should determine whether or not documented care corresponds with the quality of delivered care and the predictive value regarding clinical outcome.
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UNLABELLED: BACKGROUND; Road traffic injuries are a leading cause of death and may be related to social inequality. OBJECTIVE: To establish whether patterns of seatbelt use vary between different socioeconomic communities in the Cape Town Metropole, South Africa. METHODS: Vehicles and their occupants at 7 high-volume crossings (3 in high-income areas) were placed under surveillance for 2 hours each during November 2010. All occupants were eligible for inclusion except occupants of non-motorised vehicles, two-wheel motorised vehicles, buses, taxis, heavy goods vehicles and emergency vehicles. Child seatbelt use was recorded only for children who appeared older than 3 years. RESULTS: A total of 4 651 vehicles with 6 848 occupants were surveyed. Rates of seatbelt use were 45.1% (n=3 090) for all occupants, 54.0% (n=2 513) for drivers, 33.1% (n=521) for front-seat passengers (adults 33.2%, n=452; children 32.7%, n=69) and 9.0% (n=56) for rear-seat passengers (adults 4.0%, n=13; children 14.4%, n=43). Occupants from high-income areas were more likely to wear seatbelts (odds ratio (OR) 4.35; 95% confidence interval (CI) 3.89 - 4.88). Use of child restraints was poor overall (22.3%, n=114), but also varied according to income areas (high income 40.9%, n=99; low income 0.03%, n=6; OR 26.77; 95% CI 11.44 - 62.63). DISCUSSION: The impact of road traffic injuries is significant, but can be decreased by using appropriate restraining devices. Seatbelt use in South Africa, although compulsory, is neither strictly adhered to nor enforced. Their use is proportionally lower in lower-income areas. Specific interventions are required to target these communities directly.