Poor hospital care 'puts many lives at risk' in developing world

By Matt McGrath
Science reporter, BBC World Service

image captionPeople at the extremes of life are more at risk

Poor hospital care poses a risk to the lives of many patients in the developing world, say researchers.

A study of 26 hospitals in eight countries in the Middle East and Africa found more than one death per day in every hospital was due to preventable accidents and poor treatment.

Many deaths were due to poor staff training and supervision rather than a lack of resources, scientists said.

The study was published in The British Medical Journal.

An international team of researchers examined the hospital records of over 15,000 patients.

The research was carried out across 26 hospitals in Egypt, Jordan, Kenya, Morocco, South Africa, Tunisia, Sudan and Yemen.

Experts found that on average 8.2% suffered what they term an adverse event. These were defined as unintended injuries that resulted in permanent disability or death that came about as a result of healthcare management.

However, in some hospitals, the situation was much worse with almost one in five patients affected by accidents and poor treatments. The researchers say that adverse events happen in the developed world too, but they point out that the chances of dying from an adverse event in a developing world hospital are much higher.

Dr Ross Wilson, chief medical officer of the New York City health and hospital corporation, and the lead author of the paper, said: "Patients are suffering from poor supervision and poor performance of the clinical staff rather than a shortage of equipment or staff.

"Most commonly the diagnosis has been made but the appropriate treatment doesn't follow."

Weak systems

Dr Itziar Larizgoitia is the co-ordinator of the World Health Organization (WHO) patient safety working group. He says that hospital care is a global heath concern but it is important not to blame doctors and nurses.

"It is not the intent of health professionals to fail on patients. Rather, the harm caused by health care is often the result of failing processes and weak systems.

"Often doctors and nurses in developing countries have not received adequate training, are not adequately supervised, do not have protocols to follow nor the means to record patients' information, or in some cases, do not even have running water with which to wash their hands."

As well as the levels of training, the age of the patient and the length of their stay in hospital are also factors that can increase the chances of suffering an adverse event, according to Dr Wilson.

"The older you are the more at risk you are and if you have that event the more at risk you are of significant consequences like permanent disability or death.

"In addition the longer you are in hospital the more at risk you are, but these are the same as in the developed world. People at the extremes of life are more at risk."

The researchers are also concerned that the numbers of adverse events recorded might actually underestimate the real extent of the problem.

They point out that the death rate, at around one in three adverse events, was much higher than previously published research.

"The events are often more severe, we can't tell if that's because they are not detected sooner and responded to or if the patients are more fragile in some sense, but given the same level of problem, the patients in developing countries seem to have worse consequences."

Cultural change

In terms of what can be done, researchers are in agreement that it is not just a question of resources. According to the WHO's Dr Larizgoitia, cultural change at many levels is also required.

"Developing and adapting patient safety practices to the different cultural contexts are essential. Safety practices that work in one context may not work in another one.

"It is essential to understand which practices can work effectively in different contexts and it is also essential to facilitate and encourage the adoption of the culturally and context specific practices."

The researchers say that in at least one of the eight countries surveyed, adverse events were the fifth most common form of death after diseases of the lung and digestive system, infectious diseases and cancer.

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