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Isangula K, Ngadaya E, Manu A, Mmweteni M, Philbert D, Burengelo D, Kagaruki G, Senkoro M, Kimaro G, Kahwa A, Mazige F, Bundala F, Iriya N, Donard F, Kitinya C, Minja V, Nyakairo F, Gupta G, Pearson L, Kim M, Mfinanga S, Baker U, Hailegebriel TD. Implementation of distance learning IMCI training in rural districts of Tanzania. BMC Health Serv Res 2023; 23:56. [PMID: 36658537 PMCID: PMC9854197 DOI: 10.1186/s12913-023-09061-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants' accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania. METHODS A cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators. RESULTS About 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport. CONCLUSION DIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI.
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Affiliation(s)
- Kahabi Isangula
- National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania. .,Aga Khan University, Dar Es Salaam, Tanzania.
| | - Esther Ngadaya
- National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania.
| | - Alexander Manu
- grid.8652.90000 0004 1937 1485University of Ghana School of Public Health, Accra, Ghana ,grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Doreen Philbert
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Dorica Burengelo
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Mbazi Senkoro
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Godfather Kimaro
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Amos Kahwa
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | | | - Felix Bundala
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, Tanzania
| | - Nemes Iriya
- World Health Organization, Dar Es Salaam, Tanzania
| | - Francis Donard
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Caritas Kitinya
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Victor Minja
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Festo Nyakairo
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
| | - Gagan Gupta
- grid.420318.c0000 0004 0402 478XUNICEF Headquarters, New York, USA
| | - Luwei Pearson
- grid.420318.c0000 0004 0402 478XUNICEF Headquarters, New York, USA
| | - Minjoon Kim
- grid.420318.c0000 0004 0402 478XUNICEF Headquarters, New York, USA
| | - Sayoki Mfinanga
- grid.416716.30000 0004 0367 5636National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania
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Ariff S, Sadiq K, Jiwani U, Ahmed K, Nuzhat K, Ahmed S, Nizami Q, Khan IA, Ali N, Soofi SB, Bhutta ZA. Evaluation the Effectiveness of Abridged IMNCI (7-Day) Course v Standard (11-Day) Course in Pakistan. Matern Child Health J 2021; 26:530-536. [PMID: 34669101 PMCID: PMC8917018 DOI: 10.1007/s10995-021-03276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 12/02/2022]
Abstract
Background The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges. Methods We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training. Results The improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was − 12.4 (95% CI − 18.5, − 6.4) and − 6.4 (95% CI − 10.5, − 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was − 6.3 (95% CI − 11.3, − 1.3) in the 7-day training group and − 9.1 (95% CI − 11.5, − 6.6) in the 11-day group, p = 0.308. Conclusion An abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03276-3.
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Affiliation(s)
- Shabina Ariff
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Uswa Jiwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khalil Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khadija Nuzhat
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shakeel Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Qamruddin Nizami
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Iqtidar A Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Sajid Bashir Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. .,Center of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Sarrassat S, Lewis JJ, Some AS, Somda S, Cousens S, Blanchet K. An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:354. [PMID: 33863326 PMCID: PMC8052659 DOI: 10.1186/s12913-021-06317-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Integrated eDiagnosis Approach (IeDA), centred on an electronic Clinical Decision Support System (eCDSS) developed in line with national Integrated Management of Childhood Illness (IMCI) guidelines, was implemented in primary health facilities of two regions of Burkina Faso. An evaluation was performed using a stepped-wedge cluster randomised design with the aim of determining whether the IeDA intervention increased Health Care Workers' (HCW) adherence to the IMCI guidelines. METHODS Ten randomly selected facilities per district were visited at each step by two trained nurses: One observed under-five consultations and the second conducted a repeat consultation. The primary outcomes were: overall adherence to clinical assessment tasks; overall correct classification ignoring the severity of the classifications; and overall correct prescription according to HCWs' classifications. Statistical comparisons between trial arms were performed on cluster/step-level summaries. RESULTS On average, 54 and 79% of clinical assessment tasks were observed to be completed by HCWs in the control and intervention districts respectively (cluster-level mean difference = 29.9%; P-value = 0.002). The proportion of children for whom the validation nurses and the HCWs recorded the same classifications (ignoring the severity) was 73 and 79% in the control and intervention districts respectively (cluster-level mean difference = 10.1%; P-value = 0.004). The proportion of children who received correct prescriptions in accordance with HCWs' classifications were similar across arms, 78% in the control arm and 77% in the intervention arm (cluster-level mean difference = - 1.1%; P-value = 0.788). CONCLUSION The IeDA intervention improved substantially HCWs' adherence to IMCI's clinical assessment tasks, leading to some overall increase in correct classifications but to no overall improvement in correct prescriptions. The largest improvements tended to be observed for less common conditions. For more common conditions, HCWs in the control districts performed relatively well, thus limiting the scope to detect an overall impact. TRIAL REGISTRATION ClinicalTrials.gov NCT02341469 ; First submitted August 272,014, posted January 19, 2015.
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Affiliation(s)
- Sophie Sarrassat
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - James J Lewis
- Y Lab, the Public Services Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | | | | | - Simon Cousens
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Karl Blanchet
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Reñosa MDC, Bärnighausen K, Dalglish SL, Tallo VL, Landicho-Guevarra J, Demonteverde MP, Malacad C, Bravo TA, Mationg ML, Lupisan S, McMahon SA. "The staff are not motivated anymore": Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI) program in the Philippines. BMC Health Serv Res 2021; 21:270. [PMID: 33761936 PMCID: PMC7992320 DOI: 10.1186/s12913-021-06209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond. METHODS In-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model. RESULTS HCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols. CONCLUSION Although the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines.
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah L Dalglish
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Carol Malacad
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Mary Lorraine Mationg
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Socorro Lupisan
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Muntinlupa, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Reñosa MD, Dalglish S, Bärnighausen K, McMahon S. Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review. Glob Health Action 2020; 13:1732669. [PMID: 32114968 PMCID: PMC7067189 DOI: 10.1080/16549716.2020.1732669] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/14/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized.Purpose: To determine the key challenges affecting IMCI implementation from the perspective of health care workers (HCWs) in primary health care facilities.Methods: A scoping review based on the five-step framework of Arskey and O'Malley was utilized to identify key challenges faced by HCWs implementing the IMCI program in primary health care facilities. A comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and Google Scholar was conducted. A total of 1,475 publications were screened for eligibility and 41 publications identified for full-text evaluation. Twenty-four (24) published articles met our inclusion criteria, and were investigated to tease out common themes related to challenges of HCWs in terms of implementing the IMCI program.Results: Four key challenges emerged from our analysis: 1) Insufficient financial resources to fund program activities, 2) Lack of training, mentoring and supervision from the tertiary level, 3) Length of time required for effective and meaningful IMCI consultations conflicts with competing demands and 4) Lack of planning and coordination between policy makers and implementers resulting in ambiguity of roles and accountability. Although the IMCI program can provide substantial benefits, more information is still needed regarding implementation processes and acceptability in primary health care settings.Conclusion: Recognizing and understanding insights of those enacting health programs such as IMCI can spark meaningful strategic recommendations to improve IMCI program effectiveness. This review suggests four domains that merit consideration in the context of efforts to scale and expand IMCI programs.
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Affiliation(s)
- Mark Donald Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Manila, Philippines
| | - Sarah Dalglish
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Bärnighausen
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Manila, Philippines
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Shannon McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Doherty T, Tran N, Sanders D, Dalglish SL, Hipgrave D, Rasanathan K, Sundararaman T, Ved R, Mason E. Role of district health management teams in child health strategies. BMJ 2018; 362:k2823. [PMID: 30061110 PMCID: PMC6063257 DOI: 10.1136/bmj.k2823] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town
| | - Sarah L Dalglish
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | | | | | - Rajani Ved
- National Health Systems Resource Center, New Delhi, India
| | - Elizabeth Mason
- Institute for Global Health, University College London, London, UK
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Manzi A, Mugunga JC, Iyer HS, Magge H, Nkikabahizi F, Hirschhorn LR. Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda. PLoS One 2018; 13:e0194187. [PMID: 29547624 PMCID: PMC5856263 DOI: 10.1371/journal.pone.0194187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. Methods We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. Results The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. Conclusions The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.
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Affiliation(s)
- Anatole Manzi
- University of Rwanda, College of Medicine and Health Sciences; Kigali, Rwanda
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- * E-mail:
| | | | - Hari S. Iyer
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health; Boston, United States of America
| | - Hema Magge
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Division of General Pediatrics, Boston Children’s Hospital; Boston, United States of America
| | | | - Lisa R. Hirschhorn
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School; Boston, United States of America
- Ariadne Labs, Boston, United States of America
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Krüger C, Heinzel-Gutenbrunner M, Ali M. Adherence to the integrated management of childhood illness guidelines in Namibia, Kenya, Tanzania and Uganda: evidence from the national service provision assessment surveys. BMC Health Serv Res 2017; 17:822. [PMID: 29237494 PMCID: PMC5729502 DOI: 10.1186/s12913-017-2781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/06/2017] [Indexed: 01/29/2023] Open
Abstract
Background Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries. Methods Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient’s age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI. Results In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2–53.5%) aged 2–73 months (2–24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training. Conclusion Despite nationwide training in IMCI the adherence rates for assessment and physical examination remained low in all four countries. IMCI training should continue to be provided to all health staff, particularly nurses, midwives, and auxiliary staff, with periodic re-training and an emphasis to equally target children of all age groups.
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Affiliation(s)
- Carsten Krüger
- Department of Paediatrics, Witten/Herdecke University, Witten, Germany. .,Children's Hospital, St. Franziskus Hospital, Robert-Koch-Strasse 55, D-59227, Ahlen, Germany.
| | | | - Mohammed Ali
- Faculty of Health Sciences, School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Australia
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Mansoor GF, Chikvaidze P, Varkey S, Higgins-Steele A, Safi N, Mubasher A, Yusufi K, Alawi SA. Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan. Int J Qual Health Care 2017; 29:55-62. [PMID: 27836999 DOI: 10.1093/intqhc/mzw135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/31/2016] [Indexed: 12/22/2022] Open
Abstract
Objective To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. Design Mixed methods including cross-sectional study. Setting Thirteen (of thirty-four) provinces in Afghanistan. Participants Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities. Intervention Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities. Main outcome measures Care of sick children according to IMCI guidelines, health worker skills and essential health system elements. Results Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively. Conclusion IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness.
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Affiliation(s)
- Ghulam Farooq Mansoor
- Health Protection and Research Organization, House P 27, Street 1. Qala-e-Fathullah, District 10, Kabul City, Afghanistan
| | - Paata Chikvaidze
- World Health Organization, Afghanistan office: UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan
| | - Sherin Varkey
- United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan
| | - Ariel Higgins-Steele
- United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan
| | - Najibullah Safi
- Ministry of Public Health, Islamic Republic of Afghanistan, Great Masoud Square, Wazir Mohammad Akbar Khan, Kabul City, Afghanistan
| | - Adela Mubasher
- World Health Organization, Afghanistan office: UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan
| | - Khaksar Yusufi
- United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan
| | - Sayed Alisha Alawi
- Ministry of Public Health, Islamic Republic of Afghanistan, Great Masoud Square, Wazir Mohammad Akbar Khan, Kabul City, Afghanistan
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Rambaud-Althaus C, Shao A, Samaka J, Swai N, Perri S, Kahama-Maro J, Mitchell M, D'Acremont V, Genton B. Performance of Health Workers Using an Electronic Algorithm for the Management of Childhood Illness in Tanzania: A Pilot Implementation Study. Am J Trop Med Hyg 2016; 96:249-257. [PMID: 28077751 DOI: 10.4269/ajtmh.15-0395] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/20/2016] [Indexed: 11/07/2022] Open
Abstract
In low-resource settings, where qualified health workers (HWs) are scarce and childhood mortality high, rational antimicrobial prescription for childhood illnesses is a challenge. To assess whether smartphones running guidelines, as compared with paper support, improve consultation process and rational use of medicines for children, a pilot cluster-randomized controlled study was conducted in Tanzania. Nine primary health-care facilities (HFs) were randomized into three arms: 1) paper algorithm, 2) electronic algorithm on a smartphone, and 3) control. All HWs attending children aged 2-59 months for acute illness in intervention HFs were trained on a new clinical algorithm for management of childhood illness (ALMANACH) either on 1) paper or 2) electronic support; 4 months after training, consultations were observed. An expert consultation was the reference for classification and treatment. Main outcomes were proportion of children checked for danger signs, and antibiotics prescription rate. A total of 504 consultations (166, 171, and 167 in control, paper, and phone arms, respectively) were observed. The use of smartphones versus paper was associated with a significant increase in children checked for danger signs (41% versus 74%, P = 0.04). Antibiotic prescriptions rate dropped from 70% in the control to 26%, and 25% in paper and electronic arms. The HWs-expert agreement on pneumonia classification remained low (expert's pneumonia identified by HWs in 26%, 30%, and 39% of patients, respectively).Mobile technology in low-income countries is implementable and has a potential to improve HWs' performance. Additional point-of-care diagnostic tests are needed to ensure appropriate management. Improving the rational use of antimicrobial is a challenge that ALMANACH can help to take up.
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Affiliation(s)
- Clotilde Rambaud-Althaus
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.,Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Amani Shao
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Tukuyu Medical Research Center, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Josephine Samaka
- City Medical Office of Health, Dar es Salaam City Council, Tanzania
| | - Ndeniria Swai
- City Medical Office of Health, Dar es Salaam City Council, Tanzania
| | | | | | - Marc Mitchell
- Harvard School of Public Health, Boston, Massachusetts
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Travel Clinic, Department of Ambulatory Care and Community Medicine, and Infectious Disease Service, University of Lausanne, Lausanne, Switzerland
| | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Travel Clinic, Department of Ambulatory Care and Community Medicine, and Infectious Disease Service, University of Lausanne, Lausanne, Switzerland
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11
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Bischoff A. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study. Glob Health Action 2016; 9:29404. [PMID: 27238652 PMCID: PMC4884679 DOI: 10.3402/gha.v9.29404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. Design This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. Conclusions This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly stick to original plans that might not be working; 4) Be realistic and do not romanticise. Embarking on such a project was a timely response to the Tanzanian's government call for strengthening Primary Health Care and for rapidly accelerating the training of nurses able to work in rural areas.
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Affiliation(s)
- Alexander Bischoff
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.,School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland; ;
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12
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Gupta A, Thorpe C, Bhattacharyya O, Zwarenstein M. Promoting development and uptake of health innovations: The Nose to Tail Tool. F1000Res 2016; 5:361. [PMID: 27239275 PMCID: PMC4863676 DOI: 10.12688/f1000research.8145.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Health sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources. Methods A scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it. Results Sixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on the innovation aligning with the interests of 3 critical stakeholder groups (innovators, end users and the decision makers) and is also influenced by 3 broader contexts (social and physical environment, the health system, and the regulatory, political and economic environment). The 16 stages form the rows of the Nose to Tail Tool (NTT) grid and the 6 contingency factors form columns. The resulting stage-by-issue grid consists of 72 cells, each populated with cell-specific questions, prompts and considerations from the reviewed literature. Conclusion We offer a tool that helps stakeholders identify the stage of maturity of their innovation, helps facilitate deliberative discussions on the key considerations for each major stakeholder group and the major contextual barriers that the innovation faces. We believe the NTT will help to identify potential problems that the innovation will face and facilitates early modification, before large investments are made in a potentially flawed solution.
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Affiliation(s)
- Archna Gupta
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Cathy Thorpe
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
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13
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Novaes MLDO, Almeida RMVRD, Bastos RR. Assessing vaccine data recording in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:745-56. [DOI: 10.1590/1980-5497201500040006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/08/2015] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT: Objectives: Vaccines represent an important advancement for improving the general health of a population. The effective recording of vaccine data is a factor for the definition of its supply chain. This study investigated vaccine data recording relatively to data collected from vaccination rooms and data obtained from a government-developed Internet platform. Methods: The monthly recorded total number of diphtheria and tetanus toxoids and pertussis vaccine (alone or in combination with the Haemophilus influenzae type b conjugate vaccine) doses administered in a medium-sized city of the Southeast region of Brazil was collected for the period January/2006 through December/2010 from two sources: City level (directly from vaccination rooms, the study "gold standard"), and Federal level (from an Internet platform developed by the country government). Data from these sources were compared using descriptive statistics and the Percentage error. Results: The data values made available by the Internet platform differed from those obtained from the vaccination rooms, with a Percentage error relatively to the actual values in the range [-0.48; 0.39]. Concordant values were observed only in one among the sixty analyzed months (1.66%). Conclusions: A frequent and large difference between the number of diphtheria and tetanus toxoids and pertussis vaccine doses administered in the two levels was detected.
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14
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Geubbels E, Amri S, Levira F, Schellenberg J, Masanja H, Nathan R. Health & Demographic Surveillance System Profile: The Ifakara Rural and Urban Health and Demographic Surveillance System (Ifakara HDSS). Int J Epidemiol 2015; 44:848-61. [PMID: 25979725 DOI: 10.1093/ije/dyv068] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/13/2022] Open
Abstract
The Ifakara Rural HDSS (125,000 people) was set up in 1996 for a trial of the effectiveness of social marketing of bed nets on morbidity and mortality of children aged under 5 years, whereas the Ifakara Urban HDSS (45,000 people) since 2007 has provided demographic indicators for a typical small urban centre setting. Jointly they form the Ifakara HDSS (IHDSS), located in the Kilombero valley in south-east Tanzania. Socio-demographic data are collected twice a year. Current malaria work focuses on phase IV studies for antimalarials and on determinants of fine-scale variation of pathogen transmission risk, to inform malaria elimination strategies. The IHDSS is also used to describe the epidemiology and health system aspects of maternal, neonatal and child health and for intervention trials at individual and health systems levels. More recently, IHDSS researchers have studied epidemiology, health-seeking and national programme effectiveness for chronic health problems of adults and older people, including for HIV, tuberculosis and non-communicable diseases. A focus on understanding vulnerability and designing methods to enhance equity in access to services are cross-cutting themes in our work. Unrestricted access to core IHDSS data is in preparation, through INDEPTH iSHARE [www.indepth-ishare.org] and the IHI data portal [http://data.ihi.or.tz/index.php/catalog/central].
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Affiliation(s)
- Eveline Geubbels
- Ifakara Health Institute, Mikocheni, Dar es Salaam, Tanzania, INDEPTH Network, Kanda, Accra, Ghana, ALPHA Network, London School of Hygiene and Tropical Medicine, London, UK,
| | - Shamte Amri
- INDEPTH Network, Kanda, Accra, Ghana, Ifakara Health Institute, Ifakara Branch, Morogoro Region, Tanzania and
| | - Francis Levira
- Ifakara Health Institute, Mikocheni, Dar es Salaam, Tanzania, ALPHA Network, London School of Hygiene and Tropical Medicine, London, UK, Ifakara Health Institute, Ifakara Branch, Morogoro Region, Tanzania and
| | - Joanna Schellenberg
- Department of Disease Control and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Honorati Masanja
- Ifakara Health Institute, Mikocheni, Dar es Salaam, Tanzania, INDEPTH Network, Kanda, Accra, Ghana
| | - Rose Nathan
- Ifakara Health Institute, Mikocheni, Dar es Salaam, Tanzania, INDEPTH Network, Kanda, Accra, Ghana
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15
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Hoque DME, Arifeen SE, Rahman M, Chowdhury EK, Haque TM, Begum K, Hossain MA, Akter T, Haque F, Anwar T, Billah SM, Rahman AE, Huque MH, Christou A, Baqui AH, Bryce J, Black RE. Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh. Health Policy Plan 2013; 29:753-62. [PMID: 24038076 DOI: 10.1093/heapol/czt059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities. OBJECTIVES To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision. METHODS Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities. FINDINGS Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities. CONCLUSION IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.
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Affiliation(s)
- D M Emdadul Hoque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shams E Arifeen
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muntasirur Rahman
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Enayet K Chowdhury
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Twaha M Haque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khadija Begum
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Altaf Hossain
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tasnima Akter
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fazlul Haque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tariq Anwar
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sk Masum Billah
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ahmed Ehsanur Rahman
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Md Hamidul Huque
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aliki Christou
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdullah H Baqui
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Bryce
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Black
- Centre for Child and Adolescent Health (CCAH), ICDDR,B, Dhaka, Bangladesh, Director General of Health Services, Ministry of Health and Family Welfare, Bangladesh and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One 2013; 8:e66030. [PMID: 23776599 PMCID: PMC3680429 DOI: 10.1371/journal.pone.0066030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 05/05/2013] [Indexed: 12/04/2022] Open
Abstract
Background An estimated 6.9 million children die annually in low and middle-income countries because of treatable illneses including pneumonia, diarrhea, and malaria. To reduce morbidity and mortality, the Integrated Management of Childhood Illness strategy was developed, which included a component to strengthen the skills of health workers in identifying and managing these conditions. A systematic review and meta-analysis were conducted to determine whether IMCI training actually improves performance. Methods Database searches of CIHAHL, CENTRAL, EMBASE, Global Health, Medline, Ovid Healthstar, and PubMed were performed from 1990 to February 2013, and supplemented with grey literature searches and reviews of bibliographies. Studies were included if they compared the performance of IMCI and non-IMCI health workers in illness classification, prescription of medications, vaccinations, and counseling on nutrition and admistration of oral therapies. Dersminion-Laird random effect models were used to summarize the effect estimates. Results The systematic review and meta-analysis included 46 and 26 studies, respectively. Four cluster-randomized controlled trials, seven pre-post studies, and 15 cross-sectional studies were included. Findings were heterogeneous across performance domains with evidence of effect modification by health worker performance at baseline. Overall, IMCI-trained workers were more likely to correctly classify illnesses (RR = 1.93, 95% CI: 1.66–2.24). Studies of workers with lower baseline performance showed greater improvements in prescribing medications (RR = 3.08, 95% CI: 2.04–4.66), vaccinating children (RR = 3.45, 95% CI: 1.49–8.01), and counseling families on adequate nutrition (RR = 10.12, 95% CI: 6.03–16.99) and administering oral therapies (RR = 3.76, 95% CI: 2.30–6.13). Trends toward greater training benefits were observed in studies that were conducted in lower resource settings and reported greater supervision. Conclusion Findings suggest that IMCI training improves health worker performance. However, these estimates need to be interpreted cautiously given the observational nature of the studies and presence of heterogeneity.
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Topp SM, Chipukuma JM, Chiko MM, Matongo E, Bolton-Moore C, Reid SE. Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia. Health Policy Plan 2012; 28:347-57. [PMID: 22791556 PMCID: PMC3697202 DOI: 10.1093/heapol/czs065] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Integration of HIV treatment with other primary care services has been argued to potentially improve effectiveness, efficiency and equity. However, outside the field of reproductive health, there is limited empirical evidence regarding the scope or depth of integrated HIV programmes or their relative benefits. Moreover, the body of work describing operational models of integrated service-delivery in context remains thin. Between 2008 and 2011, the Lusaka District Health Management Team piloted and scaled-up a model of integrated HIV and general outpatient department (OPD) services in 12 primary health care clinics. This paper examines the effect of the integrated model on the organization of clinic services, and explores service providers’ perceptions of the integrated model. Methods We used a mixed methods approach incorporating facility surveys and key informant interviews with clinic managers and district officials. On-site facility surveys were carried out in 12 integrated facilities to collect data on the scope of integrated services, and 15 semi-structured interviews were carried out with 12 clinic managers and three district officials to explore strengths and weaknesses of the model. Quantitative and qualitative data were triangulated to inform overall analysis. Findings Implementation of the integrated model substantially changed the organization of service delivery across a range of clinic systems. Organizational and managerial advantages were identified, including more efficient use of staff time and clinic space, improved teamwork and accountability, and more equitable delivery of care to HIV and non-HIV patients. However, integration did not solve ongoing human resource shortages or inadequate infrastructure, which limited the efficacy of the model and were perceived to undermine service delivery. Conclusion While resource and allocative efficiencies are associated with this model of integration, a more important finding was the model’s demonstrated potential for strengthening organizational culture and staff relationships, in turn facilitating more collaborative and motivated service delivery in chronically under-resourced primary healthcare clinics.
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Affiliation(s)
- Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
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