{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T02:43:32Z","timestamp":1778985812420,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T00:00:00Z","timestamp":1541894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["#097170"],"award-info":[{"award-number":["#097170"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> recommends optimisation of available interventions to reduce deaths of under\u2010five children with diarrhoea and dehydration (<jats:styled-content style=\"fixed-case\">DD<\/jats:styled-content>). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with <jats:styled-content style=\"fixed-case\">DD<\/jats:styled-content> over the first 3\u00a0years of a clinical network.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational study involving children aged 2\u201359\u00a0months with <jats:styled-content style=\"fixed-case\">DD<\/jats:styled-content> admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> guidelines were combined using the composite Paediatric Admission Quality of Care (<jats:styled-content style=\"fixed-case\">PAQC<\/jats:styled-content>) score (range 0\u20136).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 7657 children were analysed and improvements in <jats:styled-content style=\"fixed-case\">PAQC<\/jats:styled-content> scores were observed. Predicted mean <jats:styled-content style=\"fixed-case\">PAQC<\/jats:styled-content> score for all the hospitals at enrolment was 59.8% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 5.8, 19.6). Overall mean <jats:styled-content style=\"fixed-case\">PAQC<\/jats:styled-content> score increased by 13.8% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 8.7\u201318.9, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> between hospitals: \u00b18.2) in the first 12\u00a0months, with an average 0.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.3\u20131.5, <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\u00a0\u00b1\u00a01.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adherence to guidelines for children admitted with <jats:styled-content style=\"fixed-case\">DD<\/jats:styled-content> can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13176","type":"journal-article","created":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T14:35:08Z","timestamp":1540564508000},"page":"73-80","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network"],"prefix":"10.1111","volume":"24","author":[{"given":"Samuel","family":"Akech","sequence":"first","affiliation":[{"name":"Kenya Medical Research Institute\/Wellcome Trust Research Programme Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Ayieko","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\/Wellcome Trust Research Programme Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Irimu","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\/Wellcome Trust Research Programme Nairobi Kenya"},{"name":"Department of Paediatrics and Child Health University of Nairobi Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasia","family":"Stepniewska","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine Nuffield Department of Clinical Medicine University of Oxford Oxford UK"},{"name":"Worldwide Antimalarial Resistance Network Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"English","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\/Wellcome Trust Research Programme Nairobi Kenya"},{"name":"Centre for Tropical Medicine Nuffield Department of Clinical Medicine University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Clinical Information Network authors","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001446"},{"key":"e_1_2_11_5_1","volume-title":"Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources","author":"WHO","year":"2013"},{"key":"e_1_2_11_6_1","unstructured":"iDOC+Africa.Basic Paediatric Protocols2016 2016 (Available from:http:\/\/www.idoc-africa.org\/index.php\/en\/98-about-us\/148-basic-paediatric-protocols-2016). 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