Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone

Aims To determine the cost-effectiveness of improving emergency hospital care for children in low resource countries. Methods In response to the high inpatient mortality rate at The Ola During Children9s Hospital, Freetown, Sierra Leone a team of local and international clinicians developed a plan to improve emergency care for children arriving at the hospital. Following focus group discussions with hospital staff, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of three international volunteers worked with local staff for six months to design and implement improvements in the five priority areas. The improvements were evaluated collectively rather than individually, using a basic before-and–after design. Results Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607) lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. Conclusion The cost-effectiveness of improving hospital care compares favourably to other widely implemented public health measures including insecticide treated mosquito nets ($438-2199), rota virus vaccine ($662) or the pneumococcal vaccine ($3200). With over half a million hospital beds in Sub-Saharan Africa, many of them providing sub-standard care, the expansion of such programmes could save a large number of lives and help accelerate progress towards Millennium Development Goal 4.