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Abrar S, Hafeez A, Khan MN, Marwat MI. Perspectives of healthcare workers on integrated management of childhood illness in Pakistan: A phenomenological approach. J Child Health Care 2024:13674935241238474. [PMID: 38451029 DOI: 10.1177/13674935241238474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
In 2019, an estimated 5.2 million deaths were reported among children less than 5 years of age. At primary healthcare level, healthcare workers (HCWs) mostly rely on history and clinical findings and less on inadequate diagnostic facilities. To enhance case management skills of HCWs, World Health Organization devised an integrated management of childhood illnesses (IMCI) strategy in 1995, modified to distance learning IMCI in 2014. A qualitative phenomenological study was conducted to explore perceptions of HCWs about standard and distance IMCI. Four focus group discussions were conducted with purposively selected 26 HCWs (IMCI trained) from 26 basic health units of Abbottabad district in Pakistan. Gadamer's philosophical hermeneutics were adopted during the inductive thematic analysis. Five themes that emerged are inexorable health seeking behaviors, IMCI being a comprehensive algorithm for consultation, a tedious protocol, scaling up protocol to specialists and private practitioners, and administrative insufficiency by the department of health. Improvement in case management skills of HCWs was reported as a result of IMCI trainings. It needs administrative support, regulations to control poly-pharmacy and provision of drugs without prescription, and a curb on political and bureaucratic interference.
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Affiliation(s)
- Saidul Abrar
- Department of Community Medicine, Gajju Khan Medical College, Shah Mansur, Pakistan
| | - Asad Hafeez
- World Health Representative, WHO Country Office, Safat, Kuwait
| | | | - Muhammad Imran Marwat
- Department of Community Medicine and Public Health, Khyber Medical College, Peshawar, Pakistan
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Pearson E, Rao N, Siraj I, Aboud F, Horton C, Hendry H. Workforce preparation for delivery of nurturing care in low- and middle-income countries: Expert consensus on critical multisectoral training needs. Child Care Health Dev 2024; 50:e13180. [PMID: 37807967 DOI: 10.1111/cch.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/18/2023] [Accepted: 09/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Services to support nurturing care through early childhood development (ECD) in low- and middle-income countries are hampered by significant workforce challenges. The global early childhood workforce is both diverse and complex, and it supports the delivery of a wide range of services in extremely diverse geographical and social settings. In the context of contemporary global goals for the universal provision of quality early childhood provision, there is an urgent need to build appropriate platforms for strengthening and supporting this workforce. However, the evidence base to support this work is severely limited. METHODS To contribute to evidence on how to strengthen the ECD workforce in low- and middle-income countries, this study used a Delphi methodology involving three rounds of data collection with 14 global experts, to reach consensus on the most critical training needs of three key early childhood workforce groups: (i) health; (ii) community-based paraprofessionals, and (iii) educational professionals working across ECD programmes. RESULTS The study identified a comprehensive set of shared, as well as distinct, training needs across the three groups. Shared training needs include the following: (i) nurturing dispositions that facilitate work with children and families in complex settings; (ii) knowledge and skills to support responsive, adaptable delivery of ECD programmes; and (iii) systems for ECD training and professional pathways that prioritise ongoing mentoring and support. CONCLUSIONS The study's detailed findings help to address a critical gap in the evidence on training needs for ECD workers in low-resource contexts. They provide insights into how to strengthen content, systems, and methods of training to support intersectoral ECD work in resource-constrained contexts.
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Affiliation(s)
- Emma Pearson
- College of Education, United Arab Emirates University, Abu Dhabi, United Arab Emirates
- Maynooth University, Maynooth, Ireland
| | - Nirmala Rao
- Faculty of Education, The University of Hong Kong, Hong Kong SAR, China
| | - Iram Siraj
- Department of Education, Oxford University, Oxford, UK
| | - Frances Aboud
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Caroline Horton
- Department of Psychology, Bishop Grosseteste University, Lincoln, UK
| | - Helen Hendry
- Faculty of Wellbeing, Education & Language Studies, The Open University, Milton Keynes, UK
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Al-Yahyahi M, Al Kiyumi M, Jaju S, Al Saadoon M. Perceptions of Undergraduate Medical Students Toward Integrated Management of Childhood Illness (IMCI) Pre-service Education at Sultan Qaboos University, Muscat. Cureus 2023; 15:e47260. [PMID: 38022356 PMCID: PMC10655620 DOI: 10.7759/cureus.47260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Inconsistent evidence concerning the clinical practice implications of the Integrated Management of Childhood Illness (IMCI) pre-service education exists in the literature. The aim of this study is to assess the IMCI pre-service training perceptions of medical students, including their willingness to prospectively utilize the IMCI guidelines in clinical settings. Methods This is an observational cross-sectional study that was conducted between June 1 and August 31, 2022, at the College of Medicine and Health Sciences, Sultan Qaboos University (SQU), Muscat, Sultanate of Oman. The demographic data and IMCI pre-service education perceptions were recorded via the 10 close-ended questions. The questions focused on the student's perception of the usefulness of IMCI pre-service training in improving their knowledge, attitude, and practice (KAP) regarding childhood illnesses and how well it has enhanced their skills in dealing with sick children. SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) was used to analyze the data. Results A total of 196 responses were collected, with 117 of them being from female participants and the remaining 79 from male participants. Participants were subcategorized into phase 2 (n=103), phase 3A (pre-clerkship, n=45), and phase 3B (junior clerkship, n=48). At least 67.8% of 171 medical students complying with one to two training sessions intended to apply their IMCI pre-service education knowledge and skills in clinical practice and parental counseling. The medical knowledge and clinical practice skill enhancement abilities of the IMCI sessions were recognized by ≥49.7% of medical students. The student responses regarding childhood illness management (p=0.03) and holistic assessment confidence (p=0.042) varied significantly between the study phases. The IMCI pre-service skills, knowledge, and confidence levels were observed in 47.1% (phase 2), 13.2% (phase 3A), and 35.5% (phase 3B) of medical students. Similarly, 40.2% (phase 2), 23.7% (phase 3A), and 54.8% (phase 3B) of subjects believed in the IMCI pre-service training's influence on their ability to perform holistic assessments in the pediatric population. Conclusion The overall results of this study advocate the clinical practice implications, based on the positive student perceptions, of the IMCI pre-service training in SQU. Future qualitative studies should evaluate these findings with wider student populations.
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Affiliation(s)
- Mohammed Al-Yahyahi
- Family Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | - Maisa Al Kiyumi
- Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | - Sanjay Jaju
- Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | - Muna Al Saadoon
- Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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Beynon F, Guérin F, Lampariello R, Schmitz T, Tan R, Ratanaprayul N, Tamrat T, Pellé KG, Catho G, Keitel K, Masanja I, Rambaud-Althaus C. Digitalizing Clinical Guidelines: Experiences in the Development of Clinical Decision Support Algorithms for Management of Childhood Illness in Resource-Constrained Settings. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200439. [PMID: 37640492 PMCID: PMC10461705 DOI: 10.9745/ghsp-d-22-00439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/13/2023] [Indexed: 08/31/2023]
Abstract
Clinical decision support systems (CDSSs) can strengthen the quality of integrated management of childhood illness (IMCI) in resource-constrained settings. Several IMCI-related CDSSs have been developed and implemented in recent years. Yet, despite having a shared starting point, the IMCI-related CDSSs are markedly varied due to the need for interpretation when translating narrative guidelines into decision logic combined with considerations of context and design choices. Between October 2019 and April 2021, we conducted a comparative analysis of 4 IMCI-related CDSSs. The extent of adaptations to IMCI varied, but common themes emerged. Scope was extended to cover a broader range of conditions. Content was added or modified to enhance precision, align with new evidence, and support rational resource use. Structure was modified to increase efficiency, improve usability, and prioritize care for severely ill children. The multistakeholder development processes involved syntheses of recommendations from existing guidelines and literature; creation and validation of clinical algorithms; and iterative development, implementation, and evaluation. The common themes surrounding adaptations of IMCI guidance highlight the complexities of digitalizing evidence-based recommendations and reinforce the rationale for leveraging standards for CDSS development, such as the World Health Organization's SMART Guidelines. Implementation through multistakeholder dialogue is critical to ensure CDSSs can effectively and equitably improve quality of care for children in resource-constrained settings.
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Affiliation(s)
- Fenella Beynon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Torsten Schmitz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rainer Tan
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Digital and Global Health Unit, Unisanté, Center for Primary Care and Public Health, Lausanne, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Natschja Ratanaprayul
- Department of Digital Health and Innovations, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Gaud Catho
- Division of Infectious Diseases, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Kristina Keitel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Mambulu-Chikankheni FN. Factors influencing the implementation of severe acute malnutrition guidelines within the healthcare referral systems of rural subdistricts in North West Province, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002277. [PMID: 37594922 PMCID: PMC10437970 DOI: 10.1371/journal.pgph.0002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Severe acute malnutrition (SAM) is associated with 30.9% of South Africa's audited under-five children deaths regardless of available guidelines to reduce SAM at each level of a three tyre referral system. Existing research has explored and offered solutions for SAM guidelines implementation at each referral system level, but their connectedness in continuation of care is under-explored. Therefore, I examined implementation of SAM guidelines and factors influencing implementation within subdistrict referral systems. An explanatory qualitative case study design was used. The study was conducted in two subdistricts involving two district hospitals; three community health centres, four clinics, and two emergency service stations. Between February to July 2016 and 2018, data were collected using 39 in-depth interviews with clinical, emergency service and administrative personnel; 40 reviews of records of children younger than five years; appraisals of nine facilities involved in referrals and observations. Thematic content analysis was used to analyse all data except records which were aggregated to elicit whether required SAM guidelines' steps were administered per case reviewed. Record reviews revealed SAM diagnosis discrepancies demonstrated by incomplete anthropometric assessments; non-compliance to SAM management guidelines was noted through skipping some critical steps including therapeutic feeding at clinic level. Record reviews further revealed variations of referral mechanisms across subdistricts, contradictory documentation within records, and restricted continuation of care. Interviews, observations and facility appraisals revealed that factors influencing these practices included inadequate clinical skills; inconsistent supervision and monitoring; unavailability of subdistrict specific referral policies and operational structures; and suboptimal national policies on therapeutic food. SAM diagnosis, management, and referrals within subdistrict health systems need to be strengthened to curb preventable child deaths. Implementation of SAM guidelines needs to be accompanied by job aids and supervision with standardised tools; subdistrict-specific referral policies and suboptimal national policies to ensure availability and accessibility of therapeutic foods.
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Affiliation(s)
- Faith Nankasa Mambulu-Chikankheni
- Department of Curriculum and Teaching Studies (Human Ecology), Nalikule College of Education, Lilongwe, Malawi
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Schmitz T, Beynon F, Musard C, Kwiatkowski M, Landi M, Ishaya D, Zira J, Muazu M, Renner C, Emmanuel E, Bulus SG, Rossi R. Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study. BMJ Open 2022; 12:e055315. [PMID: 35863838 PMCID: PMC9310162 DOI: 10.1136/bmjopen-2021-055315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the impact of ALgorithm for the MANAgement of CHildhood illness ('ALMANACH'), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health and quality of care outcomes for sick children attending primary healthcare (PHC) facilities. DESIGN Observational study, comparing outcomes of children attending facilities implementing ALMANACH with control facilities not yet implementing ALMANACH. SETTING PHC facilities in Adamawa State, North-Eastern Nigeria. PARTICIPANTS Children 2-59 months presenting with an acute illness. Children attending for routine care or nutrition visits (eg, immunisation, growth monitoring), physical trauma or mental health problems were excluded. INTERVENTIONS The ALMANACH intervention package (CDSS implementation with training, mentorship and data feedback) was rolled out across Adamawa's PHC facilities by the Adamawa State Primary Health Care Development Agency, in partnership with the International Committee of the Red Cross and the Swiss Tropical and Public Health Institute. Tablets were donated, but no additional support or incentives were provided. Intervention and control facilities received supportive supervision based on the national supervision protocol. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was caregiver-reported recovery at day 7, collected over the phone. Secondary outcomes were antibiotic and antimalarial prescription, referral, and communication of diagnosis and follow-up advice, assessed at day 0 exit interview. RESULTS We recruited 1929 children, of which 1021 (53%) attended ALMANACH facilities, between March and September 2020. Caregiver-reported recovery was significantly higher among children attending ALMANACH facilities (adjusted OR=2·63, 95% CI 1·60 to 4·32). We observed higher parenteral and lower oral antimicrobial prescription rates (adjusted OR=2·42 (1·00 to 5·85) and adjusted OR=0·40 (0·22 to 0·73), respectively) in ALMANACH facilities as well as markedly higher rates for referral, communication of diagnosis, and follow-up advice. CONCLUSION Implementation of digital CDSS with training, mentorship and feedback in primary care can improve quality of care and recovery of sick children in resource-constrained settings, likely mediated by better guideline adherence. These findings support the use of CDSS for health systems strengthening to progress towards universal health coverage.
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Affiliation(s)
- Torsten Schmitz
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fenella Beynon
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Capucine Musard
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marek Kwiatkowski
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marco Landi
- Regional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, Nigeria
| | - Daniel Ishaya
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Jeremiah Zira
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Muazu Muazu
- Adamawa State Primary Health Care Development Agency, Jimeta Yola, Nigeria
| | - Camille Renner
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Edwin Emmanuel
- Regional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, Nigeria
| | | | - Rodolfo Rossi
- Health Unit, International Committee of the Red Cross, Geneve, Switzerland
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Haryanti F, Laksanawati IS, Arguni E, Widyaningsih SA, Ainun NA, Rastiwi N. Evaluation of the Implementation of Integrated Management of Childhood Illness in Special Region of Yogyakarta Province, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Child mortality rate in Indonesia is now fluctuating. The Province of the Special Region of Yogyakarta (DIY) had fluctuated infant mortality rate in the recent years. As a result, guidelines of Integrated Management of Childhood Illness (IMCI) are still required to improve the health of Indonesian children.
AIM: This study aimed to explore the implementation of IMCI in DIY Province in terms of input, process, and output components.
METHODS: A case study approach with a qualitative method was conducted among implementers of IMCI in the DIY Province. The data were obtained from secondary sources, such as the reports, attendance lists, and focus group discussion video recordings.
RESULTS: The results were differentiated by input, process, and output components. Most IMCI implementers have not received special training (input); there were no specific guidelines for sick children during the COVID-19 pandemic (process); and the IMCI implementation target has not been achieved with the percentage below 60–70% (output).
CONCLUSION: The implementation of IMCI in Yogyakarta Province is still required to improve the quality of services provided to sick children.
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Jensen C, McKerrow NH. The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa. BMC Pediatr 2022; 22:80. [PMID: 35130847 PMCID: PMC8818499 DOI: 10.1186/s12887-022-03147-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Continued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources. Methods In a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers. Results From December 2019 – January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1–46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032). Conclusion The ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges.
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Affiliation(s)
- Cecilie Jensen
- Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa.
| | - Neil H McKerrow
- KwaZulu-Natal Department of Health, Paediatrics and Child Health, Pietermaritzburg, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Pelly L, Srivastava K, Singh D, Anis P, Mhadeshwar VB, Kumar R, Crockett M. Readiness to provide child health services in rural Uttar Pradesh, India: mapping, monitoring and ongoing supportive supervision. BMC Health Serv Res 2021; 21:914. [PMID: 34479540 PMCID: PMC8417968 DOI: 10.1186/s12913-021-06909-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak. METHODS Secondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed. RESULTS The median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016. CONCLUSIONS Facility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.
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Affiliation(s)
- Lorine Pelly
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
| | - Kanchan Srivastava
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Dinesh Singh
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Parwez Anis
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Vishal Babu Mhadeshwar
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Rashmi Kumar
- Department of Pediatrics, King George’s Medical University, King George’s Medical University Chowk, 226003 Lucknow, Uttar Pradesh India
| | - Maryanne Crockett
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
- Departments of Pediatrics and Child Health, Medical Microbiology and Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Rahman AE, Mhajabin S, Dockrell D, Nair H, El Arifeen S, Campbell H. Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh. BMC Health Serv Res 2021; 21:667. [PMID: 34229679 PMCID: PMC8260350 DOI: 10.1186/s12913-021-06659-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as 'essential' for pneumonia management. RESULTS More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8-10), whereas 20% had a low-readiness (score 0-4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). CONCLUSION There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- University of Edinburgh, Edinburgh, UK.
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Shema Mhajabin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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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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Salazar-Austin N, Milovanovic M, West NS, Tladi M, Barnes GL, Variava E, Martinson N, Chaisson RE, Kerrigan D. Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services. BMC Nurs 2021; 20:29. [PMID: 33557831 PMCID: PMC7869510 DOI: 10.1186/s12912-021-00544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00544-z.
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Affiliation(s)
- Nicole Salazar-Austin
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street Room 3147, Baltimore, MD, 21287, USA. .,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Nora S West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Molefi Tladi
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Grace Link Barnes
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ebrahim Variava
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Klerksdorp/Tshepong Hospital Complex, North West Province Department of Health, Klerksdorp, South Africa and University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of Witwatersrand, Johannesburg, South Africa.,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Murdoch J, Curran R, Cornick R, Picken S, Bachmann M, Bateman E, Simelane ML, Fairall L. Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child). BMC Health Serv Res 2020; 20:479. [PMID: 32471431 PMCID: PMC7257217 DOI: 10.1186/s12913-020-05201-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0–13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017–2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.
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Affiliation(s)
- Jamie Murdoch
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Colney Lane, Norwich, NR4 7TJ, UK.
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Makhosazana Lungile Simelane
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.,King's Global Health Institute, King's College London, London, SE1 9NH, UK
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Tshivhase L, Madumo MM, Govender I. Challenges facing professional nurses implementing the Integrated Management of Childhood Illness programme in rural primary health care clinics, Limpopo Province, South Africa. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 32501038 PMCID: PMC8378005 DOI: 10.4102/safp.v62i1.5060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Under-five mortality and morbidity could be reduced through increased implementation of the Integrated Management of Childhood Illness (IMCI) strategy. The aim of the study was to determine challenges facing IMCI-trained professional nurses on implementing this strategy when managing children less than 5 years of age. METHODS A quantitative descriptive survey method was used. The target populations were IMCI-trained professional nurses with the sample of 208 respondents. Data were collected through self-report questionnaires and analysed using statistical analysis system software. RESULTS The implementation of the IMCI strategy by IMCI-trained professional nurses in Vhembe primary health care (PHC) clinics continues to face challenges, making it difficult for professional nurses to follow guidelines. These challenges range from staff barriers, management barriers, poor management process and poor infrastructure. All these challenges lead to poor-quality under-five patient care. CONCLUSION Regardless of the IMCI strategy being implemented since its inception in 1999, the under-five mortality remains not reduced. This is related to the identified challenges facing the IMCI-trained professional nurses implementing the strategy.
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Affiliation(s)
- Livhuwani Tshivhase
- Department of Nursing, Faculty of Health Science, Sefako Makgatho Health Sciences University, Pretoria.
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15
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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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16
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Bernasconi A, Crabbé F, Adedeji AM, Bello A, Schmitz T, Landi M, Rossi R. Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research. PLoS One 2019; 14:e0225634. [PMID: 31790448 PMCID: PMC6886837 DOI: 10.1371/journal.pone.0225634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool. METHODS We carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given. RESULTS In comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p<0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p<0.01) and correct treatment (48.4% vs. 29.5%, p<0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p<0.05). CONCLUSIONS Our findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.
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Affiliation(s)
| | - Francois Crabbé
- HTTU, Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Attahiru Bello
- Adamawa State Primary Healthcare Development Agency, Adamawa, Nigeria
| | - Torsten Schmitz
- HTTU, Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Carai S, Kuttumuratova A, Boderscova L, Khachatryan H, Lejnev I, Monolbaev K, Uka S, Weber M. Review of Integrated Management of Childhood Illness (IMCI) in 16 countries in Central Asia and Europe: implications for primary healthcare in the era of universal health coverage. Arch Dis Child 2019; 104:1143-1149. [PMID: 31558445 PMCID: PMC6900244 DOI: 10.1136/archdischild-2019-317072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022]
Abstract
The Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, antibiotics misuse, polypharmacy and overhospitalisation. This study in 16 countries analyses status, strengths of and barriers to IMCI implementation and investigates how health systems affect the problems IMCI aims to address. 220 key informants were interviewed ranging from 5 to 37 per country (median 12). Data were analysed for arising themes and peer-reviewed. IMCI has not been fully used either as a strategy or as an algorithmic diagnostic and treatment decision tool. Inherent incentives include: economic factors taking precedence over evidence and the best interest of the child in treatment decisions; financing mechanisms and payment schemes incentivising unnecessary or prolonged hospitalisation; prescription of drugs other than IMCI drugs for revenue generation or because believed superior by doctors or parents; parents' perception that the quality of care at the primary healthcare level is poor; preference for invasive treatment and medicalised care. Despite the long-standing recognition that supportive health systems are a requirement for IMCI implementation, efforts to address health system barriers have been limited. Making healthcare truly universal for children will require a shift towards health systems designed around and for children and away from systems centred on providers' needs and parents' expectations. Prerequisites will be sufficient remuneration, sound training, improved health literacy among parents, conducive laws and regulations and reimbursement systems with adequate checks and balances to ensure the best possible care.
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Affiliation(s)
- Susanne Carai
- University Witten Herdecke Faculty of Medicine, Witten, Germany .,World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Larisa Boderscova
- WHO CO Moldova, World Health Organization Regional Office for Europe, Chisinau, Moldova
| | - Henrik Khachatryan
- WHO CO Armenia, World Health Organization Regional Office for Europe, Yerevan, Armenia
| | - Ivan Lejnev
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Kubanychbek Monolbaev
- WHO CO Kyrgyzstan, World Health Organization Regional Office for Europe, Bishkek, Kyrgyzstan
| | - Sami Uka
- WHO Office Pristina, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Martin Weber
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Meno FO, Makhado L, Matsipane M. Factors inhibiting implementation of Integrated Management of Childhood Illnesses (IMCI) in primary health care (PHC) facilities in Mafikeng sub-district. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Bernasconi A, Crabbé F, Raab M, Rossi R. Can the use of digital algorithms improve quality care? An example from Afghanistan. PLoS One 2018; 13:e0207233. [PMID: 30475833 PMCID: PMC6261034 DOI: 10.1371/journal.pone.0207233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/27/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Quality of care is a difficult parameter to measure. With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old. METHODS More than one year after the introduction of digital algorithms, we carried out two cross sectional studies to assess the improvements in comparison with the situation prior to the implementation of the project, in two Basic Health Centres in Kabul province. One survey was carried out inside the consultation room and was based on the direct observation of 181 consultations of children aged 2 months to 5 years old, using a checklist completed by a senior physicians. The second survey queried 181 caretakers of children outside the health facility for their opinion about the consultation carried out through the tablet and prescriptions and medications given. RESULTS We measured the quality of care as adherence to the IMCI's guidelines. The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription. We noticed a dramatic improvement (p<0.05) of several indicators following the introduction of digital algorithms. The baseline physical examination was appropriate only for 23.8% [IC% 19.9-28.1] of the patients, 34.5% [IC% 30.0-39.2] received a correct treatment and 86.1% [IC% 82.4-89.2] received at least one antibiotic. With the introduction of digital algorithms, these indicators statistically improved respectively to 84.0% [IC% 77.9-88.6], >85% and less than 30%. CONCLUSIONS Our findings suggest that digital algorithms improve quality of care by applying the guidelines more effectively. Our experience should encourage to test this tool in different settings and to scale up its use at province/state level.
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Affiliation(s)
- Andrea Bernasconi
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - François Crabbé
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Raab
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rodolfo Rossi
- PHC programs, International Committee of the Red Cross, Genève, Switzerland
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