Global use of the WHO Pocket Book of Hospital Care for Children

Background: Studies in the last decade have identified major deficiencies in the care of seriously ill children in hospitals in developing countries. Effective implementation of clinical guidelines is an important strategy for improving quality of care. In 2005 the World Health Organization produced the Pocket Book of Hospital Care for Children - Guidelines for Management of Common Childhood Illnesses in Rural and District Hospitals with Limited Resources. Objective: To determine the worldwide distribution, uptake and use of the WHO Pocket Book of Hospital Care for Children. Methods: A systematic online and postal survey was conducted to assess coverage and uptake of the Pocket Book in low- and middle-income countries (LMICs). More than 1000 key stakeholders with varied roles and responsibilities for child health in 194 countries were invited to participate. Indicators used to measure implementation of the guidelines included local adaptation, use as standard treatment and incorporation into undergraduate and postgraduate training. Results: Information was gathered from 354 respondents representing 134 countries; these included 98 LMICs and 50 countries with under-5 childhood mortality rates>40 deaths/1000 live births. Sixty-four LMICs (44% of 145 LMICs worldwide) including 42 high-mortality countries (66% of 64 high-mortality countries worldwide) reported at least partial implementation of the Pocket Book. However, uptake remains fragmented within countries. Conclusion: More than half of all LMICs with high rates of child mortality have reported use and substantial implementation activities, a considerable achievement given minimal resources available for implementation. Improving the accessibility of the Pocket Book and its implementation tools to health workers, and developing a strategic approach to implementation in each country could improve quality of hospital care for children and support efforts towards achieving the Millennium Development Goal 4 targets.