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Wellcome Trust funded project with University of Cape Town exploring how children with life-threatening illness access (or often fail to access) appropriate health care. Critically ill and injured children often die before they can be admitted to a centre providing high quality intensive care, or arrive with such late stage disease that management is prolonged and sometimes futile. There is a lack of evidence about the relative importance and frequency of care failures at different points in the emergency care pathway, which is crucial for prioritising allocation of resources to achieve improvements in emergency care and a reduction in child deaths.

The confidential enquiry approach  is essentially an independent expert audit of a series of cases which explicitly avoids attributing blame to individuals but seeks to identify modifiable system failure. This approach has been used successfully in other settings (such as maternal mortality in the UK) with findings that have led to implementations and positive system improvements.

This approach was piloted and modified to the Cape Town setting across the disciplines involved in paediatric critical care. A full scale study is now underway and due for completion by December 2012. Based on the results of the study the methodology will be adapted to other African locations.

Please contact the lead investigator, Alison Ward for further information.