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A healthy, balanced and nutritious diet for children and young people is essential for normal growth and development. Vending machines can be a source of food and drink high in fat, sugar and salt, and can undermine healthy eating messages. The purpose of this paper is to examine the contents of vending machines available in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals in Wales.

Questionnaires are completed by staff in the Department of Child Health in each NHS Trust in Wales. This paper summarises the results.

Most vending machines found in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals in Wales contain a majority of foods high in fat salt and sugar. Only a few contain over 50 per cent of drinks classified as healthy.

There is no universally agreed definition of healthy food as related to individual products. This study looks at the availability of foods and drinks classified as “unhealthy” but does not look at the overall diet of the children in the ward.

The results of this study should encourage NHS Trusts to consider the contents of vending machines in the vicinity of paediatric wards and paediatric out‐patient departments in hospitals.

There is much rhetoric around the potential of vending machines to contribute to an unhealthy diet. This is the first paper to identify specific problems with hospital vending machines.

The objective of this study is to investigate the existence of a diurnal pattern in the occurrence of adverse clinical management events.

The approach takes the form of a retrospective record review of adverse clinical management events occurring in the 63 facilities of a statutory public health provider in rural south‐eastern Australia. Between January 2006 and December 2007, 2,463 clinical management incidents were reported by clinical staff to a specially designed database.

Adverse clinical management incidents exhibit a marked diurnal pattern. This pattern was evident in both medicine and surgery as well as across facilities of differing acuity. The acrophase or peak of the daily cycle occurs at 14:30 hrs (95%CI 13:25 and 15:34 hrs). Although surgical events peaked earlier in the day (14.02hrs: 95%CI 12:32‐15:32) compared with medicine events (15:26hrs: 95%CI 13:07‐15:32), this difference was not statistically significant.

As the activity rate in the hospital is unknown, this finding study reports the time of the day when most adverse events occur and not their rate as a function of procedural volume.

The existence of a diurnal pattern provides valuable information for strategies aimed at improving patient safety and health care quality. Interventions can now be more accurately targeted.

The paper is the first to move beyond descriptive data of the timing of adverse events and offers a model using chronobiological methods. The demonstration of the existence of diurnal patterns should improve programmes to reduce adverse events.

The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers’ perceptions of quality of neonatal care in health facilities in Ghana.

Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns.

The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering.

Limited number of health providers and facilities used, lack of exploration of parents of neonates’ perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure.

This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of neonatal health care in health facilities in Ghana and in countries with similar challenges.

The study found that the majority of nursing staff catering for sick newborns were not trained in neonatal nursing. Babies were found sleeping in separate cots but were mixed with older children. The study suggests that babies should be provided with a separate room and not mixed with older babies.

There seemed to be no defined policy framework for management of neonatal care in the country’s health care facilities. The study recommends the adoption of paediatric and neonatal care nursing as a specialty in the curricula of health training institutions. In-service trainings should encompass issues related to management of sick babies, care of preterm babies, neonatal resuscitation and intravenouscannulation, among others.

Parental satisfaction with paediatric home care has previously been found to be high and the results presented here confirm this finding. This study is unique in that a well defined population from one geographical area was studied before and after the introduction of the new home care service. Referrers included general practitioners, doctors in emergency care and out‐patient clinics, referring children for a wide range of acute conditions. Compared with hospital admission only half the number of adverse effects on children and families were reported by parents. Interest has been increasing in alternative service provision to prevent or reduce paediatric hospital admissions to avoid adverse effects on children and families. This study examined the views of parents experiencing hospital at home compared with hospital referral between 1999 and 2001 across the whole spectrum of acute clinical conditions. Hospital at home was the preferred service for a wide range of illnesses. Parents and carers identified extension of hospital at home to 24‐hour cover as a future preference. Parental preference for paediatric hospital at home for acute illness was confirmed.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

The purpose of this paper is to provide an “inside” account of efforts to enhance the quality of care in a paediatric hospital department in Malawi.

The authors describe the problems they face as health workers in an overcrowded, under-resourced emergency departments in a low-income setting. Where it is helpful, the authors combine reports of their experience with reference to reports emanating from other African countries.

There is increased awareness of the need for a good health system to be able to provide quality care. The authors emphasise the importance of teamwork and the need for cross cutting activities that are not disease-centred or vertically driven. Task sharing and multi-tasking have helped fill the gaps left by inadequate staffing but specialists in emergency medicine are needed to advocate for the specialty and be role models in departments.

This paper is aimed at a broad audience of fellow clinicians, funders and policy makers, and those who have an interest in clinical governance in support of quality improvement in developing countries.

This is a firsthand account of efforts to enhance the quality of emergency care from a paediatric hospital department in Malawi.

The paper's purpose is to document a clinical study of children with Henoch‐Schonlein Purpura that facilitated decision‐making with regard to investigations, follow up and timely referral to a nephrologist.

A retrospective analysis of clinical records of 33 children diagnosed with Henoch‐Schonlein purpura who attended the Whiston Hospital Paediatric unit over a 60‐month period between January 2001 and December 2005 was performed.

In the study 53 per cent (n 17) of the patients were boys. The commonest age group affected was between five to ten years (n 17), with mean age of 7.2 years (range 1 to 17 years). Of the cases , 71 per cent (n 22) presented between July and December. Four patients (13 per cent) had haematuria on dipstick examination at presentation. Eight patients (25 per cent) had neither blood pressure measurement on admission nor a documented plan for urine dipstick or blood pressure measurement on discharge. Daily urine dipstick was performed in 47 per cent (n 15) patients with one patient having checks twice a week. Information to parents was not documented in 72 per cent (n 23) of case notes.

The need to provide better parental education and support in the form of an information leaflet was identified.

This study highlights the importance of follow up of children with HSP with emphasis on regular urine dipstick examination and measurement of blood pressure even if they remain asymptomatic to ensure that they do not develop long‐term renal impairment.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute–community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

Sensorineural hearing loss is a common sequel of bacterial meningitis in childhood and hearing assessment post‐meningitis is therefore essential. An audit performed of practice in a tertiary centre paediatric unit over 24 months in 1994‐1995 showed an 89 per cent referral and 81 per cent attendance rate for audiological assessment following bacterial meningitis. A repeat retrospective audit was performed over 12 months in 1998‐1999 following the introduction of guidelines and measures to improve education of medical staff and communication between professionals. This achieved a 100 per cent referral and attendance rate in a series of 27 children surviving bacterial meningitis in 1998‐1999, demonstrating the success of the process of the complete audit cycle in improving clinical practice.