249 - Missed Opportunities in Global Pediatric Non-Communicable Disease Care: Ambulatory-Care Sensitive Hospitalizations and Follow-up Adherence in Nepal

Publication Number: 1236.249

Neha Limaye, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Beena Prajapati, Dhulikhel Hospital, Bhaktapur, Bagmati, Nepal; Kshitij Chapagain, Dhulikhel Hospital, DHULIKHEL, Bagmati, Nepal; Samridhi Dawadi, Kathmandu University School of Medical Sciences, Kathmandu, Bagmati, Nepal; D'Andria Hollins, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, United States; Ranjana Karki, Dhulikhel Hospital, KUSMS, Dhulikhel, Bagmati, Nepal; Archana Shreshta, KuSMs, Dhulikhel, Bagmati, Nepal; Mary A.. Ott, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: The population of pediatric and adolescent patients with non-communicable diseases (NCDs) is growing globally, but care systems for pediatric NCDs are limited across most lower-resource settings. In Nepal, half of the country's NCD burden falls on children and individuals under 40, but data on pediatric NCDs are scarce. Of particular concern are data on preventable hospitalizations and missed follow-ups, as these represent areas for potential intervention.

Objective: To describe trends in NCD-related hospital admissions among children and adolescents at one of Nepal's major hospitals and identify factors associated with ambulatory-care sensitive hospitalizations and follow-up adherence.

Design/Methods: Retrospective chart review of NCD-related admissions in individuals aged 0-19 in a large tertiary care hospital in Nepal, between April 2023 and October 2024. We reviewed discharge summaries to collect data on demographics, medical history, hospital course, follow-up, and readmission. We screened admissions for ambulatory care sensitive conditions (ACSCs), defined as conditions where timely outpatient care could prevent hospitalization, based on multiple global guidelines. Follow-up adherence was defined as returning to the pediatrics outpatient department within the timing recommended at discharge. We de-identified the data and analyzed with descriptive and inferential statistics in STATA.

Results: 277 NCD patients aged 0-19 were admitted between April 1, 2023, and October 1, 2024. The mean age was 10.5 years; 55.2% were male, and 61.4% lived in urban municipalities. The average hospital stay was 4.2 days. Patients lived on average 59 kilometers from the hospital and 55% of patients had government insurance. ACSCs accounted for 70% of admissions, most commonly convulsions (16% of admissions) and asthma (8% of admissions). Follow-up adherence was 60%. There were no significant differences in odds of admission for an ACSC by insurance status or distance from the hospital (Table 1). For follow-up adherence, patients with government insurance had 2.5 times higher odds of follow up within recommended time, both in adjusted and unadjusted analyses (Table 2).

Conclusion(s): The majority of pediatric NCD hospitalizations were due to ACSCs, and many patients did not adhere to recommended follow-up. Lack of government insurance was associated with significantly lower rates of follow-up. These results highlight missed opportunities in pediatric and adolescent NCD management, and suggest the need for programs improving linkage to health insurance and outpatient care to strengthen care for this population in Nepal.

Table 1: Association Between Demographic Characteristics and Admission for Ambulatory-Care Sensitive Condition

*Adjusted model included the following covariates: Age, gender, race/ethnicity, level of care during hospitalization, and length of stay.


Table 2: Association Between Demographic Characteristics and Follow-up Adherence
*Adjusted model included the following covariates: Age, gender, race/ethnicity, level of care during hospitalization, and length of stay.