P3.094: Improving Nurses’ Recognition of Danger Signs and Transfer Management in Pediatric Illnesses in Nyanza District, Rwanda: An International Community Access to Child Health (ICATCH) Initiative

Background: Nyanza District Hospital, one of 44 district hospitals in Rwanda, serves a population of approximately 320,000. It admits 120–140 sick children monthly, nearly all of whom are referred from 17 surrounding health centers are staffed by nurses and midwives. About 40% of these children arrive in critical condition, often with severe dehydration, hypovolemic shock, hypoxemia, or severe malnutrition. Delays in recognizing and referring critically ill children, often due to limited training among primary care staff, contribute to preventable morbidity and mortality.

The aim is to improve early recognition of pediatric danger signs, enhance pre-referral management, and expedite timely transfer of critically ill children to reduce morbidity hence mortality.

Methods: This ongoing ICATCH project involves annual training of nurses on the recognition of danger signs and pre-referral management, followed by a structured mentorship program. Ten health centers with the highest number of critical referrals were selected. A mentorship team, consisting of four medical officers and one pediatrician, conducts monthly two-day visits to each center. Training and mentorship are based on the Emergency Triage, Assessment, and Treatment Plus (ETAT+) protocol, with a strong focus on practical skills. Baseline and post-training data on illness severity at admission are collected and analyzed.The nurses’ knowledge of danger sign recognition improved after the training from 69.6% to 80.4% in Year 1, and from 62.9% to 86.7% in Year 2. A total of 205 pre-intervention records and 330 post-intervention records were reviewed. Most patients were male (62.4%) and aged 1–12 months. Common diagnoses included dehydration, respiratory distress, and sepsis. Critically ill admissions from participating health centers decreased from 37.5% at baseline to 31.2% in Year 1 and 13.7% in Year 2.

Results: The nurses’ knowledge of danger sign recognition improved after the training from 69.6% to 80.4% in Year 1, and from 62.9% to 86.7% in Year 2. A total of 205 pre-intervention records and 330 post-intervention records were reviewed. Most patients were male (62.4%) and aged 1–12 months. Common diagnoses included dehydration, respiratory distress, and sepsis. Critically ill admissions from participating health centers decreased from 37.5% at baseline to 31.2% in Year 1 and 13.7% in Year 2.

Conclusion: Training nurses in early recognition of danger signs using the ETAT+ protocol, combined with ongoing mentorship, significantly improves pre-referral management and reduces delays in the transfer of critically ill children, ultimately reducing pediatric morbidity.