ArticleImplementation science : IS2017
A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda.
Article in Implementation science : IS, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review.BMC health services research · 2025Pooled it
- Implementation practice models for development in low- and middle-income countries: systematic review of peer-reviewed literature.BMC public health · 2022Pooled it
- Non-typhoidal Salmonella co-infect and complicate Plasmodium falciparum malaria in children under-five: A prospective cohort study on clinical presentation and outcome in Kisantu district hospital, DR Congo.PLoS neglected tropical diseases · 2026Observational
- Identifying barriers and facilitators to implementing triage systems in low- and middle-income countries: A scoping review.PLOS global public health · 2026Article
- The Unmet Critical Care Burden at a Central Hospital in a Resource-Limited Setting: A Point Prevalence Study.World journal of surgery · 2025Article
- Confronting Hypoxemic Respiratory Failure in Africa: If Not Now, When?Annals of the American Thoracic Society · 2025Article
- Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security.The Lancet. Global health · 2025Review
- Pulse oximetry training landscape for healthcare workers in low- and middle-income countries: A scoping review.Journal of global health · 2023Article
- A health systems approach to critical care delivery in low-resource settings: a narrative review.Intensive care medicine · 2023Review
- Prevalence of gastrointestinal bleeding and frequency of selected predictors of mortality on the medical emergency ward at Mulago hospital.African health sciences · 2023Article
- Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children.Acta paediatrica (Oslo, Norway : 1992) · 2022Article
- Trends in guideline implementation: an updated scoping review.Implementation science : IS · 2022Article
- Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-Resource Settings-A Two-Arm Interventional Feasibility Study.Frontiers in pediatrics · 2022Article
- Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2021Article
- Clinical and microbiological characterization of sepsis and evaluation of sepsis scores.PloS one · 2021Observational
- Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting - modern diagnostics meet age-old challenges.BMC health services research · 2020Article
- Do different patient populations need different early warning scores? The performance of nine different early warning scores used on acutely ill patients admitted to a low-resource hospital in sub-Saharan Africa.Clinical medicine (London, England) · 2020Article
- The global need for essential emergency and critical care.Critical care (London, England) · 2018Article
- Observational
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundTo improve management of severely ill hospitalized patients in low-income settings, the World Health Organization (WHO) established a triage tool called "Quick Check" to provide clinicians with a rapid, standardized approach to identify patients with severe illness based on recognition of abnormal vital signs. Despite the availability of these guidelines, recognition of severe illness remains challenged in low-income settings, largely as a result of infrequent vital sign monitoring.
methodsWe conducted a staggered, pre-post quasi-experimental study at four inpatient health facilities in western Uganda to assess the impact of a multi-modal intervention for improving quality of care following formal training on WHO "Quick Check" guidelines for diagnosis of severe illness in low-income settings. Intervention components were developed using the COM-B ("capability," "opportunity," and "motivation" determine "behavior") model and included clinical mentoring by an expert in severe illness care, collaborative improvement meetings with external support supervision, and continuous audits of clinical performance with structured feedback.
resultsThere were 5759 patients hospitalized from August 2014 to May 2015: 1633 were admitted before and 4126 during the intervention period. Designed to occur twice monthly, collaborative improvement meetings occurred every 2-4 weeks at each site. Clinical mentoring sessions, designed to occur monthly, occurred every 4-6 months at each site. Audit and feedback reports were implemented weekly as designed. During the intervention period, there were significant increases in the site-adjusted likelihood of initial assessment of temperature, heart rate, blood pressure, respiratory rate, mental status, and pulse oximetry. Patients admitted during the intervention period were significantly more likely to be diagnosed with sepsis (4.3 vs. 0.4%, risk ratio 10.1, 95% CI 3.0-31.0, p < 0.001) and severe respiratory distress (3.9 vs. 0.9%, risk ratio 4.5, 95% CI 1.8-10.9, p = 0.001).
conclusionsTheory-informed quality improvement programs can improve vital sign collection and diagnosis of severe illness in low-income settings. Further implementation, evaluation, and scale-up of such interventions are needed to enhance hospital-based triage and severe illness management in these settings.
trial registrationSevere illness management system (SIMS) intervention development, ISRCTN46976783.
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