Paediatric care in hospitals in Kyrgyzstan and Tajikistan: impact of a quality improvement initiative.

Background: Adequate quality of paediatric care remains one of the key factors for reducing child mortality and improving child health in Central Asia. We aimed to assess the quality of paediatric care in hospitals in Kyrgyzstan and Tajikistan before and after a two-year intervention. We implemented a multifaceted approach to improve healthcare quality, focussing on case management, hospital policies, and service organisation. Methods: We assessed the quality of care in nine hospitals in Kyrgyzstan and ten hospitals in Tajikistan, using a World Health Organization paediatric hospital care assessment tool. The assessment considered three main pillars of care: hospital support services, case management, and policies and organisation of services. We collected the data through direct observation, analysis of general hospital data, case files, policies and procedures, clinical guidelines, reports and interviews with staff, management, and caretakers. We compared the scores (0-3) at baseline with those at the end of the project. Results: We found many areas of inadequate care at the baseline assessments in both countries. The endline assessment showed improvements in areas such as clinical management of acute respiratory infections, staff training, hospital policies, and the reduction of unnecessary painful procedures. The management of pneumonia, including the use of appropriate antibiotics and oxygen therapy, has improved in most hospitals in both countries. The mean score for assessing suspected pneumonia improved from 2.1 to 2.7 (P = 0.018) in Kyrgyzstan and from 1.6 to 2.1 (P = 0.020) in Tajikistan. Unnecessary, painful, and invasive procedures decreased from 70% to 48% of cases in Tajikistan and from 66% to 36% in Kyrgyzstan. Gaps remained in infrastructure, chronic disease management, and the rational use of medicines. Conclusions: A set of quality improvement measures led to improvements in the hospitals. Irrational antibiotic prescribing, overmedicalisation, and unjustified hospitalisation continue to be issues related to the broader health system. Systemic issues, including human resource constraints, infrastructure limitations, and supply shortages, need to be addressed. Scaling up the project to other hospitals would improve the overall quality of care.