P3.087: Expert Consensus on Quality Measures for the Management of Severe Malaria Complications in Children Under Five in Sub-Saharan Africa: A Modified Delphi Study

Purpose/Objectives: Malaria remains a leading cause of mortality among children under five in low-and-middle-income countries (LMICs). Approximately 420,000 deaths occur annually in children under five due to complications of malaria, including cerebral malaria, severe anemia, and renal failure, with over 90% of these deaths occurring in sub-Saharan Africa (SSA).

Suboptimal quality of care significantly contributes to preventable harm and mortality in LMICs. Quality measures (QMs), which systematically assess healthcare delivery, have facilitated improvements in pediatric care outcomes. In 2018, the World Health Organization (WHO) published QMs targeting many diseases with high morbidity and mortality in children under five. However, few QMs specifically address the management of severe malaria and its complications.

This study seeks to establish QMs for managing severe malaria complications in children under five admitted to tertiary hospitals in SSA.

Design/Methods: We conducted a modified Delphi study using iterative survey rounds to achieve expert consensus. The study included three separate phases: expert panel (EP) recruitment, initial QM development, and the Delphi process.

EP recruitment: A call for nominations was distributed via global health listservs of major national pediatric organizations, seeking frontline pediatricians with minimum 3 years’ post medical school experience working in SSA.

QM Development: The research team drafted an initial set of 37 QMs for management of severe malaria complications in children. These QMs were derived from existing literature and modeled after WHO QMs for other pediatric diseases.

Delphi process:
1. Rounds 1-3: Using an online survey, panelists rated each proposed QMs as accepted, accepted with modifications, or rejected. Measures with ≥80% agreement were accepted, those with < 50% were discarded, and those with 50-80% agreement were revised and re-evaluated by the EP in subsequent rounds.
2. Final Round: Experts evaluated the finalized QMs based on the National Quality Forum (NQF) criteria of importance, acceptability, usability, and feasibility.

Results: The EP included 14 frontline pediatricians from diverse SSA countries. Consensus was achieved on all 37 QMs within the three Delphi rounds. Of the 37 initial QMs, 11 required modification before acceptance. The final QMs were categorized into input, process/ output, and outcome measures, and address the four most common causes of severe malaria-related morbidity and mortality: severe anemia, cerebral malaria, hypoglycemia, acute kidney Injury (Table 1 – Final QMs with NQF Ratings).

Conclusion/Discussion: This study successfully generated an expert consensus-derived set of QMs for the management of severe malaria complications, addressing a critical gap in pediatric malaria care. By establishing a more standardized framework to assess and improve clinical care, these QMs have the potential to reduce preventable mortality, enhance adherence to evidence-based practices, and inform national and institutional QI initiatives. These measures will serve as a foundation for future implementation and research efforts, driving sustained improvements in pediatric malaria care.