Ethiopia has made significant progress in reducing under-five mortality through policy changes, technological advancements, and improved health services, particularly via the Health Extension Program (HEP). However, data on pediatric hospital admissions and mortality patterns remain limited. Recent evidence suggests that supporting health workers, structuring clinical care, and optimizing resource use can improve outcomes for hospitalized children. Quality improvement strategies include setting standards, using assessment tools, encouraging participation, and harnessing driving forces.

Early identification of at-risk patients, appropriate care matching, and resource allocation are crucial for high-quality medical care. Early warning scores (EWS), which provide an objective measure of a patient’s condition, can identify early signs of clinical deterioration, enabling timely intervention to prevent cardiopulmonary arrest and improve survival.

Although evidence on improving hospital care quality in low-income countries is limited, observational studies indicate that EWS can enhance detection of clinical deterioration and response systems in hospitals. While emergency assessment tools are well-documented in developed countries, their validation in resource-limited settings is needed to address high mortality rates due to different causes of morbidity and mortality. Increasing the adoption of such systems could significantly reduce mortality in these high-burden areas.

Objective and Outcomes

objective of this project is to develop and validate a pediatric early warning score which can be used at hospitals in Ethiopia. The expected end outcome is a well validated both paper based and m-Health scoring tool. Over the long term this tool can be modified and be used in health centers and health posts to guide early intervention and referral. The most important addressable impact of this project will be reduction of in hospital mortality.

Study Period and Location

This study, conducted from July 2017 to June 2018, focuses on children admitted to the pediatric wards of University of Gondar Hospital (GUH), located 765 km northwest of Addis Ababa. GUH, the largest referral hospital in northern Ethiopia, has 400 beds and admits about 5,000 pediatric patients annually. The Pediatrics Department includes neonatal, emergency, main, oncology, nutrition wards, and intensive care units. The study aims to analyze pediatric admission patterns and outcomes to inform targeted care interventions.

Implementation Phases

The implementation has two major steps. The first one is the development of early warning score followed by the validation. Clinical data will be collected from the patient’s medical records in prospective case-control study, starting from admission to discharge. Data will be entered and analyzed using Stata 14. After the development and validation of the score the second and major step will be development of user friendly paper based and m-health supported scoring tool.What makes this a significant innovation is it is an assessment tool which will be used for both inpatient admission and can be used for referral of patients from district hospitals and primary health care centers. The other part of the innovation is it is both paper based and mobile based assessment tool.