1
|
Sarma H, Giang PN, Kelly M, Van Anh T, Rao C, Hoa NP. Knowledge of Medical Education on Maternal and Child Primary-Care Among Physicians: A Cross-Sectional Study. Int J Public Health 2024; 69:1606536. [PMID: 39027014 PMCID: PMC11254614 DOI: 10.3389/ijph.2024.1606536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives To assess the pre-training knowledge of Commune Health Stations (CHSs) physicians in Vietnam on pregnancy and child care. Methods A cross-sectional study was conducted and a pre-training questionnaire was administered with physicians working at CHSs in three mountainous provinces of northern Vietnam. Calculated mean knowledge score and estimated adjusted odds ratios (AOR) to compare the relative odds of occurrence of the outcome "answering more than half of questions correct," given exposure to the physicians' characteristics. Results A total of 302 CHS physicians participated. The mean number of correct answers across all participants was 5.4 out of 11. Female physicians are 2.20 (95% CI: 1.35-3.59, p = 0.002) times more likely to answer correctly than their male counterparts. Physicians aged 35 years or more were significantly less likely to answer correctly (AOR 0.35, 95% CI: 0.15-0.81, p = 0.014). Conclusion The study found that participating physicians possessed relatively low knowledge of pregnancy and child care. The study also found significant disparities in this knowledge according to the physicians' characteristics. Thus, it is recommended the requirement for continuing targeted medical education to improve doctors' proficiency in these areas.
Collapse
Affiliation(s)
- Haribondhu Sarma
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Pham Ngan Giang
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
| | - Matthew Kelly
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Tran Van Anh
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
| | - Chalapati Rao
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Nguyen Phuong Hoa
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
| |
Collapse
|
2
|
Desmond N, Henrion MYR, Gondwe M, O’Byrne T, Iroh Tam PY, Nyirenda D, Pollock L, Majamanda MD, Makwero M, Geldof M, Dube Q, Phiri C, Banda C, Kachala R, Heyderman PRS, Masesa C, Lufesi N, Lalloo DG. Improving care pathways for children with severe illness through implementation of the ASPIRE mHealth primary ETAT package in Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002786. [PMID: 38683833 PMCID: PMC11057765 DOI: 10.1371/journal.pgph.0002786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
Providing emergency care in low resource settings relies on delivery by lower cadres of health workers (LCHW). We describe the development, implementation and mixed methods evaluation of a mobile health (mHealth) triage algorithm based on the WHO Emergency, Triage, Assessment, and Treatment (ETAT) for primary-level care. We conducted an observational study design of implementation research. Key stakeholders were engaged throughout implementation. Clinicians and LCHW at eight primary health centres in Blantyre district were trained to use an mHealth algorithm for triage. An mHealth patient surveillance system monitored patients from presentation through referral to tertiary and final outcome. A total of 209,174 children were recorded by ETAT between April 2017 and September 2018, and 155,931 had both recorded mHealth and clinician triage outcome data. Concordance between mHealth triage by lower cadres of HCW and clinician assessment was 81·6% (95% CI [81·4, 81·8]) over all outcomes (kappa: 0·535 (95% CI [0·530, 0·539]). Concordance for mHealth emergency triage was 0.31 with kappa 0.42. The most common mHealth recorded emergency sign was breathing difficulty (74·1% 95% CI [70·1, 77·9]) and priority sign was raised temperature (76·2% (95% CI [75·9, 76·6]). A total of 1,644 referrals out of 3,004 (54·7%) successfully reached the tertiary site. Both providers and carers expressed high levels of satisfaction with the mHealth ETAT pathway. An mHealth triage algorithm can be used by LCHWs with moderate concordance with clinician triage. Implementation of ETAT through an mHealth algorithm documented successful referrals from primary to tertiary, but half of referred patients did not reach the tertiary site. Potential harms of such systems, such as cases requiring referral being missed during triage, require further evaluation. The ASPIRE mHealth primary ETAT approach can be used to prioritise acute illness and support future resource planning within both district and national health system.
Collapse
Affiliation(s)
- Nicola Desmond
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marc Y. R. Henrion
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mtisunge Gondwe
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Thomasena O’Byrne
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Pui-Ying Iroh Tam
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Deborah Nyirenda
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Louisa Pollock
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Maureen Daisy Majamanda
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martha Makwero
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- World Health Organization, Geneva, Switzerland
| | | | - Queen Dube
- Ministry of Health, Lilongwe, Malawi
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimwemwe Phiri
- Department of Anthropology, University of Durham, Durham, United Kingdom
| | - Chimwemwe Banda
- International Food Policy Research Institute, Lilongwe, Malawi
| | | | - Prof Robert S. Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College London, United Kingdom
| | - Clemens Masesa
- Social Sciences Research Group, and Paediatrics and Child Health Research Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
3
|
Koko D, Arouna D, Bernard YM, Ba T, Mostel J, Abdou Y, Coulibaly E, Bahari-Tohon Z, Barat LM. How Outreach Training and Supportive Supervision (OTSS) Affect Health Facility Readiness and Health-Care Worker Competency to Prevent and Treat Malaria in Niger: A Secondary Analysis of OTSS Data. Am J Trop Med Hyg 2024; 110:50-55. [PMID: 38320312 PMCID: PMC10919237 DOI: 10.4269/ajtmh.23-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/27/2023] [Indexed: 02/08/2024] Open
Abstract
The quality of health services is key to the goal of averting morbidity and mortality from malaria. From July 2020 to August 2021, PMI Impact Malaria supported the implementation of four rounds of Outreach Training and Supportive Supervision (OTSS) in 12 health districts in the two regions of Niger: Dosso and Tahoua. Through OTSS, trained supervisors conducted onsite visits to observe an average of 174 healthcare workers (HCWs) per round in 96 public primary health facilities, managing persons with fever or conducting antenatal care (ANC) consultations, and then provided instant and individualized feedback and onsite training. Data from health facility readiness, case management, and malaria in pregnancy (MiP) checklists across the four rounds were analyzed using Wilcoxon's and the χ2 tests. These analyses highlighted improved facility readiness, including an increased likelihood that HCWs had received classroom training, and facilities had increased availability of guidelines and algorithms by round 4 compared with round 1. Median HCW performance scores showed an improvement in the correct performance and interpretation of malaria rapid diagnostic tests, in classification of malaria as uncomplicated or severe, and in the management of uncomplicated malaria across the four rounds. For MiP services, malaria prevention and the management of pregnant women with malaria also improved from round 1 to round 4. These findings provide further evidence that OTSS can achieve rapid improvements in health facility readiness and HCW competency in managing outpatients and ANC clients.
Collapse
Affiliation(s)
- Daniel Koko
- PMI Impact Malaria Project, Population Services International, Niamey, Republic of Niger
| | - Djibrilla Arouna
- PMI Impact Malaria Project, Population Services International, Niamey, Republic of Niger
| | - Yves-Marie Bernard
- PMI Impact Malaria Project, Population Services International, Washington, District of Columbia
| | - Thierno Ba
- PMI Impact Malaria Project, Population Services International, Washington, District of Columbia
| | - Jadmin Mostel
- PMI Impact Malaria Project, Population Services International, Washington, District of Columbia
| | - Yahaya Abdou
- National Malaria Program, Niamey, Republic of Niger
| | - Eric Coulibaly
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Niamey, Republic of Niger
| | - Zilahatou Bahari-Tohon
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Niamey, Republic of Niger
| | - Lawrence M. Barat
- PMI Impact Malaria Project, Population Services International, Washington, District of Columbia
| |
Collapse
|
4
|
Horwood C, Haskins L, Mapumulo S, Connolly C, Luthuli S, Jensen C, Pansegrouw D, McKerrow N. Electronic Integrated Management of Childhood Illness (eIMCI): a randomized controlled trial to evaluate an electronic clinical decision-making support system for management of sick children in primary health care facilities in South Africa. BMC Health Serv Res 2024; 24:177. [PMID: 38331824 PMCID: PMC10851465 DOI: 10.1186/s12913-024-10547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. METHODS We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. RESULTS Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. CONCLUSIONS Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov ID: BFC157/19, August 2019.
Collapse
Affiliation(s)
- C Horwood
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Haskins
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Mapumulo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - C Connolly
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Luthuli
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - C Jensen
- Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa
| | - D Pansegrouw
- KwaZulu-Natal Department of Health, Ilembe District, Stanger, South Africa
| | - N 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
| |
Collapse
|
5
|
Khongo BD, Schmiedeknecht K, Aron MB, Nyangulu PN, Mazengera W, Ndarama E, Tenner AG, Baltzell K, Connolly E. Basic emergency care course and longitudinal mentorship completed in a rural Neno District, Malawi: A feasibility, acceptability, and impact study. PLoS One 2023; 18:e0280454. [PMID: 36745667 PMCID: PMC9901771 DOI: 10.1371/journal.pone.0280454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/03/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Frontline providers mostly outside specific emergency areas deliver emergency care around the world, yet often they do not receive dedicated training in managing emergency conditions. When designed for low-resource settings, emergency care training has been shown to improve provider skills, facilitate efficient use of available resources, and reduce death and disability by ensuring timely access to life-saving care. METHODS The WHO/ICRC Basic Emergency Care (BEC) Course with follow up longitudinal mentorship for 6 months was implemented in rural Neno District Malawi from September 2019-April 2020. We completed a mixed-methods analysis of the course and mentorship included mentor and participant surveys and feedback, mentorship quantification, and participant examination results. Simple descriptive statistics and boxplot visuals were used to describe participant demographics and mentorship quantification with a Wilcoxon signed-rank test to evaluate pre- and post-test scores. Qualitative feedback from participants and mentors were inductively analyzed using Dedoose. RESULTS The median difference of BEC course examination percentage score between participants before the BEC course and immediately following the course was 18.0 (95% CI 14.0-22.0; p<0.001). Examination scores from the one-year post-test was lower but sustained above the pre-course test score with a median difference of 11.9 (95% CI 4.0-16.0; p<0.009). There were 174 mentorship activities with results suggesting that a higher number of mentorship touches and hours of mentor-mentee interactions may assist in sustained knowledge test scores. Reported strengths included course delivery approach leading to improved knowledge with mentorship enhancing skills, learning and improved confidence. Suggestions for improvement included more contextualized training and increased mentorship. CONCLUSION The BEC course and subsequent longitudinal mentorship were feasible and acceptable to participants and mentors in the Malawian low resource context. Follow-up longitudinal mentorship was feasible and acceptable and is likely important to cementing the course concepts for long-term retention of knowledge and skills.
Collapse
Affiliation(s)
| | - Kelly Schmiedeknecht
- Department of Family Health Care Nursing, Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | | | | | | | - Andrea G. Tenner
- Department of Emergency Medicine WHO Collaborating Centre for Emergency, Critical, and Operative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Division of Hospital Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| |
Collapse
|
6
|
Khan AM, Sultana S, Ahmed S, Shi T, McCollum ED, Baqui AH, Cunningham S, Campbell H. The ability of non-physician health workers to identify chest indrawing to detect pneumonia in children below five years of age in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2023; 13:04016. [PMID: 36730094 PMCID: PMC9894506 DOI: 10.7189/jogh.13.04016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Non-physician health workers play a vital role in diagnosing and treating pneumonia in children in low- and middle-income countries (LMICs). Chest indrawing is a key indicator for pneumonia diagnosis, signifying the severity of the disease. We conducted this systematic review to summarize the evidence on non-physician health workers' ability to identify chest indrawing to detect pneumonia in children below five years of age in LMICs. Methods We comprehensively searched four electronic databases, including MEDLINE, Embase, Web of Science, and Scopus, and reference lists from the identified studies, from January 1, 1990, to January 20, 2022, with no language restrictions. Studies evaluating the performance of non-physician health workers in identifying chest indrawing compared to a reference standard were included. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the methodological quality of the selected studies and conducted a meta-analysis following a bivariate random effects model to estimate the pooled sensitivity and specificity. Results We identified nine studies covering 4468 children that reported the accuracy of a non-physician health worker in identifying chest indrawing. Most studies were conducted in the 1990s, based at health facility settings, with children aged 2-59 months, and with pediatricians/physicians as the reference standard. Using the QUADAS-2, we evaluated most studies as having a low risk of bias and a low concern regarding applicability in all domains. The median sensitivity, specificity, positive predictive value, and negative predictive value were 44%, 97%, 55%, and 95%, respectively. We selected five studies for the meta-analysis. The pooled sensitivity was 46% (95% confidence interval (CI) = 37-56), and the pooled specificity was 95% (95% CI = 91-97). Conclusions We found the ability of non-physician health workers in LMICs in identifying chest indrawing pneumonia is relatively poor. Appropriate measures, such as targeted identification and training, supportive supervision, regular performance assessment, and feedback for those who have a poor ability to recognize chest indrawing, should be taken to improve the diagnosis of pneumonia in children. New studies are needed to assess the new generation of health workers. Registration PROSPERO (CRD42022306954).
Collapse
Affiliation(s)
- Ahad Mahmud Khan
- Usher Institute, University of Edinburgh, Edinburgh, UK,Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Salahuddin Ahmed
- Usher Institute, University of Edinburgh, Edinburgh, UK,Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Ting Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Eric D McCollum
- Eudowood Division of Paediatric Respiratory Sciences, Department of Paediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | | | | |
Collapse
|
7
|
Horwood C, Luthuli S, Mapumulo S, Haskins L, Jensen C, Pansegrouw D, McKerrow N. Challenges of using e-health technologies to support clinical care in rural Africa: a longitudinal mixed methods study exploring primary health care nurses' experiences of using an electronic clinical decision support system (CDSS) in South Africa. BMC Health Serv Res 2023; 23:30. [PMID: 36639801 PMCID: PMC9840278 DOI: 10.1186/s12913-022-09001-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Electronic decision-making support systems (CDSSs) can support clinicians to make evidence-based, rational clinical decisions about patient management and have been effectively implemented in high-income settings. Integrated Management of Childhood Illness (IMCI) uses clinical algorithms to provide guidelines for management of sick children in primary health care clinics and is widely implemented in low income countries. A CDSS based on IMCI (eIMCI) was developed in South Africa. METHODS We undertook a mixed methods study to prospectively explore experiences of implementation from the perspective of newly-trained eIMCI practitioners. eIMCI uptake was monitored throughout implementation. In-depth interviews (IDIs) were conducted with selected participants before and after training, after mentoring, and after 6 months implementation. Participants were then invited to participate in focus group discussions (FGDs) to provide further insights into barriers to eIMCI implementation. RESULTS We conducted 36 IDIs with 9 participants between October 2020 and May 2021, and three FGDs with 11 participants in October 2021. Most participants spoke positively about eIMCI reporting that it was well received in the clinics, was simple to use, and improved the quality of clinical assessments. However, uptake of eIMCI across participating clinics was poor. Challenges reported included lack of computer skills which made simple tasks, like logging in or entering patient details, time consuming. Technical support was provided, but was time consuming to access so that eIMCI was sometimes unavailable. Other challenges included heavy workloads, and the perception that eIMCI took longer and disrupted participant's work. Poor alignment between recording requirements of eIMCI and other clinic programmes increased participant's administrative workload. All these factors were a disincentive to eIMCI uptake, frequently leading participants to revert to paper IMCI which was quicker and where they felt more confident. CONCLUSION Despite the potential of CDSSs to increase adherence to guidelines and improve clinical management and prescribing practices in resource constrained settings where clinical support is scarce, they have not been widely implemented. Careful attention should be paid to the work environment, work flow and skills of health workers prior to implementation, and ongoing health system support is required if health workers are to adopt these approaches (350).
Collapse
Affiliation(s)
- Christiane Horwood
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Silondile Luthuli
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sphindile Mapumulo
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- grid.16463.360000 0001 0723 4123Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Cecilie Jensen
- grid.463338.90000 0001 2157 3236Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa
| | - Deidre Pansegrouw
- KwaZulu-Natal Department of Health, Ilembe District, KwaDukuza, South Africa
| | - Neil McKerrow
- KwaZulu-Natal Department of Health, Paediatrics and Child Health, Pietermaritzburg, South Africa ,grid.7836.a0000 0004 1937 1151Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa ,grid.16463.360000 0001 0723 4123Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
Blanchet K, Sanon VP, Sarrassat S, Somé AS. Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso. Int J Health Policy Manag 2023; 12:6073. [PMID: 37579445 PMCID: PMC10125132 DOI: 10.34172/ijhpm.2022.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change. METHODS Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the middle-range theory (MRT). RESULTS Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach, task monitoring, training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams. CONCLUSION This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers' attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies.
Collapse
Affiliation(s)
- Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Graduate Institute, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | |
Collapse
|
9
|
Baruwa S, Tobey E, Okafor E, Afolabi K, Akomolafe TO, Ubuane I, Anyanti J, Jain A. The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria. BMC Health Serv Res 2022; 22:981. [PMID: 35915491 PMCID: PMC9340708 DOI: 10.1186/s12913-022-08360-0] [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] [Received: 02/09/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background CPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria. Methods In a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance. Results Majority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01–8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14–3.99, p-value = 0.02). Conclusion Community Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.
Collapse
Affiliation(s)
- Sikiru Baruwa
- Population Council, House 4, No. 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria.
| | | | | | | | - Toyin O Akomolafe
- Population Council, House 4, No. 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Innocent Ubuane
- Population Council, House 4, No. 16 Mafemi Crescent, Off Solomon Lar Way, Utako, Abuja, Nigeria
| | | | | |
Collapse
|
10
|
Refay ASE, Shehata MA, Sherif LS, Nady HGE, Kholoussi N, Kholoussi S, Baroudy NRE, Gomma MR, Mahmoud SH, Shama NMA, Bagato O, Taweel AE, kandeil A, Ali MA. Prevalence of viral pathogens in a sample of hospitalized Egyptian children with acute lower respiratory tract infections: a two-year prospective study. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:103. [PMID: 35431533 PMCID: PMC9006499 DOI: 10.1186/s42269-022-00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Viral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children. RESULTS This prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza-3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus. CONCLUSIONS Viral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.
Collapse
Affiliation(s)
- Amira S. El Refay
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Manal A. Shehata
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Lobna S. Sherif
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Hala G. El Nady
- Child Health Department, National Research Centre, 33 El-Bohouth Street (Former El Tahrir St.), PO Box 12622, Dokki, Giza, Egypt
| | - Naglaa Kholoussi
- Immunogenetics Department, National Research Centre, Dokki, Egypt
| | - Shams Kholoussi
- Immunogenetics Department, National Research Centre, Dokki, Egypt
| | | | - Mokhtar R. Gomma
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Sara H. Mahmoud
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Noura M. Abo Shama
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ola Bagato
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ahmed El Taweel
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Ahmed kandeil
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| | - Mohamed A. Ali
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, Egypt
| |
Collapse
|
11
|
Amboko B, Stepniewska K, Malla L, Machini B, Bejon P, Snow RW, Zurovac D. Determinants of improvement trends in health workers' compliance with outpatient malaria case-management guidelines at health facilities with available "test and treat" commodities in Kenya. PLoS One 2021; 16:e0259020. [PMID: 34739519 PMCID: PMC8570506 DOI: 10.1371/journal.pone.0259020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health workers' compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. METHODS Data from 11 national, cross-sectional health facility surveys undertaken from 2010-2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). RESULTS Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite "test and treat" performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the "test and treat" policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers' gender, correct health workers' knowledge about the targeted malaria treatment policy, and patients' main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. CONCLUSIONS Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers' knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.
Collapse
Affiliation(s)
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Beatrice Machini
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dejan Zurovac
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
12
|
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.
Collapse
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
| | | |
Collapse
|
13
|
Emgård M, Mwangi R, Mayo C, Mshana E, Nkini G, Andersson R, Msuya SE, Lepp M, Muro F, Skovbjerg S. Tanzanian primary healthcare workers' experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study. Antimicrob Resist Infect Control 2021; 10:94. [PMID: 34176486 PMCID: PMC8237496 DOI: 10.1186/s13756-021-00952-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. Methods A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. Findings Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. Conclusions To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00952-5.
Collapse
Affiliation(s)
- Matilda Emgård
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Rose Mwangi
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Celina Mayo
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Ester Mshana
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Gertrud Nkini
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Østfold University College, Fredrikstad, Norway.,School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Florida Muro
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania.,Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
14
|
Perales NA, Wei D, Khadka A, Leslie HH, Hamadou S, Yama GC, Robyn PJ, Shapira G, Kruk ME, Fink G. Quality of clinical assessment and child mortality: a three-country cross-sectional study. Health Policy Plan 2021; 35:878-887. [PMID: 32577749 DOI: 10.1093/heapol/czaa048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/14/2022] Open
Abstract
This analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2-59 months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016. These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2-59 months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2-59 months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14.1% (adjusted odds ratio (aOR) 95% CI: 0.025-0.244) reduction in the odds of mortality at age 2-59 months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3% (aOR 95% CI: 0.058-0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2-59 months could be possible if compliance were improved.
Collapse
Affiliation(s)
- Nicole A Perales
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94720, USA
| | - Dorothy Wei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Aayush Khadka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.,Graduate School of Arts and Sciences, Harvard University, 350 Massachusetts Avenue, Cambridge MA 02138, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Saïdou Hamadou
- Health, Nutrition and Population Unit, The World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | | | - Paul Jacob Robyn
- Health, Nutrition and Population Unit, The World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Gil Shapira
- Development Research Group, The World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Socinstrasse 57, Basel 4051, Switzerland
| |
Collapse
|
15
|
Crocker M, Loughlin CE, Esther CR, Noah T, Fernández SP, Woo G, Parajón LC, Parajón D, Becker-Dreps S. Community health worker case-detection of asthma or reactive airways disease in a resource-poor community in Nicaragua. Pediatr Pulmonol 2021; 56:1145-1154. [PMID: 33241927 DOI: 10.1002/ppul.25187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Asthma is a major cause of morbidity and mortality in children worldwide, but many cases may remain undiagnosed. Community health worker (CHW) programs have improved detection of other diseases such as childhood pneumonia, but none have been validated for detection of asthma in resource-poor settings. We hypothesized that a CHW administered questionnaire would be effective in case-detection of asthma in a poor Nicaraguan community. METHODS We enrolled children aged 2-17 from a small semiurban Nicaraguan community. A trained CHW administered a questionnaire based on a previously validated school-based screening questionnaire, which was compared to pediatric pulmonologist evaluation as a reference standard. We determined the questionnaire's sensitivity, specificity, and positive and negative likelihood ratios at different score cut-points. RESULTS A total of 199 out of 218 eligible children were enrolled. Total asthma prevalence based on physician diagnosis was 33%. Mean scores on the CHW questionnaire were 3.6 points out of 22 (SD = 4.3) for nonasthmatics and 11.0 points (SD = 5.3) for children with asthma (p < .001). Area under the curve was 0.87. Multivariable analysis showed increased association of asthma/reactive airways disease with respiratory infection in the first 3 months of life and with family history of asthma. CONCLUSIONS Prevalence of asthma in this community was high compared to previously reported national prevalence (15.2%), possibly due to increased exposure to risk factors. The questionnaire had a high area under the receiver operating characteristic curve, making it an excellent screening tool. This questionnaire could greatly increase the detection of asthma, allowing for education and referral for ongoing care.
Collapse
Affiliation(s)
- Mary Crocker
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles R Esther
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Terry Noah
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Díaz-Cardenas S, Perez-Puello SDC, Ramos-Martínez KDR. Enfermedades prevalentes de la infancia detectadas en atención odontológica y prácticas clave AIEPI. DUAZARY 2021. [DOI: 10.21676/2389783x.3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
En el presente estudio se asociaron Enfermedades Prevalentes en la Infancia (EPI), detectadas en atención odontológica, con variables sociodemográficas y prácticas claves AIEPI (Atención Integral a Enfermedades Prevalentes de la Infancia) en binomios madres-niños, menores de 5 años, afrodescendientes de Cartagena-Colombia. Se realizó un estudio descriptivo transversal en madres de 23.400 niños menores de 5 años. La muestra fue de 548 binomios seleccionados por muestreo probabilístico aleatorio durante atención odontológica en Jornada de Salud. Se aplicó instrumento de investigaciones operativas en AIEPI (cuestionario); se estimaron EPI ocurridas en los últimos 7 días y prácticas claves AIEPI realizadas frente a estas. Se reportaron frecuencias, proporciones, regresión de Poisson con varianza robusta para asociar EPI con variables sociodemográficas y prácticas claves AIEPI. Las EPI detectadas desde la atención odontológica fueron principalmente resfriado, caries dental y diarrea; la práctica clave AIEPI más realizada fue lactancia materna exclusiva (80,4%). Hubo asociación entre la aparición de EPI y no contar con servicios de salud público (RP =1,16; p=0,023), no cepillar los dientes de los niños después de tomar biberón o mamar y antes de dormir (RP=1,08; p=0,022 y RP= 0,90; p=0,006 respectivamente).
Collapse
|
18
|
Kilov K, Hildenwall H, Dube A, Zadutsa B, Banda L, Langton J, Desmond N, Lufesi N, Makwenda C, King C. Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi. BMJ Paediatr Open 2021; 5:e001044. [PMID: 34013071 PMCID: PMC8098945 DOI: 10.1136/bmjpo-2021-001044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The introduction of the WHO's Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been reported. We aimed to determine resource availability and healthcare worker knowledge of IMCI guidelines in two districts in Malawi. METHODS We conducted a mixed-methods study, including health facility audits to record availability and functionality of essential IMCI equipment and availability of IMCI drugs, healthcare provider survey and focus group discussions (FGDs) with facility staff. The study was conducted between January and April 2019 in Mchinji (central region) and Zomba (southern region) districts. Quantitative data were described using proportions and χ2 tests; linear regression was conducted to explore factors associated with IMCI knowledge. Qualitative data were analysed using a pragmatic framework approach. Qualitative and quantitative data were analysed and presented separately. RESULTS Forty-seven health facilities and 531 healthcare workers were included. Lumefantrine-Artemether and cotrimoxazole were the most available drugs (98% and 96%); while amoxicillin tablets and salbutamol nebuliser solution were the least available (28% and 36%). Respiratory rate timers were the least available piece of equipment, with only 8 (17%) facilities having a functional device. The mean IMCI knowledge score was 3.96 out of 10, and there was a statistically significant association between knowledge and having received refresher training (coeff: 0.42; 95% CI 0.01 to 0.82). Four themes were identified in the FGDs: IMCI implementation and practice, barriers to IMCI, benefits of IMCI and sustainability. CONCLUSION We found key gaps in IMCI implementation; however, these were not homogenous across facilities, suggesting opportunities to learn from locally adapted IMCI best practices. Improving on-going mentorship, training and supervision should be explored to improve quality of care, and programming which moves away from vertical financing with short-term support, to a more holistic approach with embedded sustainability may address the balance of resources for different conditions.
Collapse
Affiliation(s)
- Kim Kilov
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | | | - Lumbani Banda
- Parent and Child Health Initiative, Lilongwe, Malawi
| | - Josephine Langton
- Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Norman Lufesi
- Acute Respiratory Infections Unit, Ministry of Health, Lilongwe, Malawi
| | | | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Institute for Global Health, University College London, London, UK
| |
Collapse
|
19
|
Bhura M, Ariff S, Qazi SA, Qazi Z, Ahmed I, Nisar YB, Suhag Z, Soomro AW, Soofi SB. Evaluating implementation of "management of Possible Serious Bacterial Infection (PSBI) when referral is not feasible" in primary health care facilities in Sindh province, Pakistan. PLoS One 2020; 15:e0240688. [PMID: 33052981 PMCID: PMC7556471 DOI: 10.1371/journal.pone.0240688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background The World Health Organization (WHO) launched a guideline in 2015 for managing Possible Serious Bacterial Infection (PSBI) when referral is not feasible in young infants aged 0–59 days. This guideline was implemented across 303 Basic Health Unit (BHU) Plus primary health care (PHC) facilities in peri-urban and rural settings of Sindh, Pakistan. We evaluated the implementation of PSBI guideline, and the quality of care provided to sick young infants at these facilities. Methods Thirty (10%) out of 303 BHU Plus facilities were randomly selected for evaluation. A survey team visited each facility for one day, assessed the health system support, observed the management of sick young infants by health care providers (HCP), validated their management, interviewed HCPs and caretakers of sick infants. HCPs who were unable to see a young infant on the day of survey were evaluated using pre-prepared case scenarios. Results Thirty (100%) BHU Plus facilities had oral amoxicillin, injectable gentamicin, thermometers, baby weighing scales and respiratory timers available; 29 (97%) had disposable syringes and needles; 28 (93%) had integrated management of childhood illness (IMCI)/PSBI chart booklets and job aids and 18 (60%) had a functional ambulance. Each facility had at least one HCP trained in PSBI, and 21 (70%) facilities had been visited by a supervisor in the preceding six months. Of 42 HCPs, 19 (45.3%) were trained within the preceding 12 months. During the survey, 26 sick young infants were identified in 18 facilities. HCPs asked about history of breastfeeding in 23 (89%) infants, history of vomiting in 17 (65%), and history of convulsions in 14 (54%); weighed 25 (97%) infants; measured respiratory rate in all (100%) and temperature in 24 (92%); assessed 20 (77%) for movement and 14 (54%) for chest indrawing. HCPs identified two infants with fast breathing pneumonia and managed them correctly per IMCI/PSBI protocol. HCPs identified six (23%) infants with clinical severe infection (CSI), two of them were referred to a higher-level facility, only one accepted the referral advice. Only one CSI patient was managed correctly per IMCI/PSBI protocol at the outpatient level. HCPs described the PSBI danger signs to eight (31%) caretakers. Caretakers of five infants with CSI and two with pneumonia were not counselled for PSBI danger signs. Five of the six CSI cases categorized by HCPs were validated as CSI on re-examination, whereas one had pneumonia. Similarly, one of the two pneumonia patients categorized by HCPs had CSI and one identified as local bacterial infection was classified as CSI upon re-examination. Conclusion Health system support was adequate but clinical management and counselling by HCPs was sub-optimal particularly with CSI cases who are at higher risk of adverse outcomes. Scaling up PSBI management is potentially feasible in PHC facilities in Pakistan, provided that HCPs are trained well and mentored, receive refresher training to appropriately manage sick young infants, and have adequate supplies and counselling skills.
Collapse
Affiliation(s)
- Maria Bhura
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shamim Ahmad Qazi
- Retired from Department of Maternal, Newborn, Child, and Adolescent Health, WHO, Working as a WHO Consultant, Geneva, Switzerland
| | | | - Imran Ahmed
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Yasir bin Nisar
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Zamir Suhag
- People’s Primary Healthcare Initiative, Sindh, Pakistan
| | | | - Sajid Bashir Soofi
- Center of Excellance in Women & Child Health, Aga Khan University, Karachi, Pakistan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail:
| |
Collapse
|
20
|
Denno DM, Plesons M, Chandra-Mouli V. Effective strategies to improve health worker performance in delivering adolescent-friendly sexual and reproductive health services. Int J Adolesc Med Health 2020; 33:269-297. [PMID: 32887182 DOI: 10.1515/ijamh-2019-0245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/22/2020] [Indexed: 11/15/2022]
Abstract
Background Despite recognition of the important role of health workers in providing adolescent-friendly sexual and reproductive health services (AFSRHS), evidence on strategies for improving performance is limited. This review sought to address: (1) which interventions are used to improve health worker performance in delivering AFSRHS? and (2) how effective are these interventions in improving AFSRHS health worker performance and client outcomes? Methods Building on a 2015 review, a search for literature on 18 previously identified programs was conducted to identify updated literature and data relevant to this review. Data was systematically extracted and analyzed. Results Due to the parent review's eligibility criteria, all programs included health worker training. Otherwise, supervision was the most frequently reported intervention used (n=10). Components and methods related to quality of trainings and supervision varied considerably in program reports. Nearly half of programs described employing processes to ensure availability of basic medicines and supplies (n=7). Other interventions (policies, standards, and job descriptions [n=5]; refresher trainings [n=5]; job aids or other reference material [n=3]) were less commonly reported to have been employed. No discernible patterns emerged in the relationship between interventions and outcomes of interest. Conclusions Multi-faceted complementary strategies are recommended to improve health worker performance to deliver AFSRHS; however, this was uncommonly reported in the programs that we reviewed. Effectiveness and cost-effectiveness evaluations of interventions and intervention packages are needed to guide efficient use of limited resources to enhance health worker capacity to deliver AFSRHS. In the interim, programs should be developed and implemented based on available existing evidence on improving health worker performance within and outside adolescent health. Implications and contribution This review is the first to examine the interventions commonly used to improve health worker performance in delivering AFSRHS. The findings indicate a need for additional effectiveness and cost-effectiveness evaluations of such interventions. In the meantime, existing evidence on improving health worker performance within and outside adolescent health must be integrated more thoughtfully into program planning and implementation.
Collapse
Affiliation(s)
- Donna M Denno
- Department of Pediatrics and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Marina Plesons
- Department of Sexual and Reproductive Health and Research, World Health Organization and the Human Reproduction Programme, 20 Avenue Appia, Geneva1211,Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Sexual and Reproductive Health and Research, World Health Organization and the Human Reproduction Programme, 20 Avenue Appia, Geneva1211,Switzerland
| |
Collapse
|
21
|
Measuring accuracy of plethysmography based respiratory rate measurement using pulse oximeter at a tertiary hospital in India. Pneumonia (Nathan) 2020; 12:4. [PMID: 32518740 PMCID: PMC7273681 DOI: 10.1186/s41479-020-00067-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background Childhood pneumonia continues to be a major infectious killer in India. WHO recommended respiratory rate and oxygen saturation (SpO2) measurements are not well implemented in Indian public health outpatient facilities with the result that treatment decision-making rely on subjective assessments from variably trained and supervised healthcare providers. The introduction of a multi-modal pulse oximeter (POx) that gives reliable measurements would mitigate incorrect diagnosis. In light of future potential use of pulse oximeter in peripheral health centres, it becomes important to measure accuracy of respiratory rate and oxygen saturation of such an instrument. The current study measures accuracy of plethysmography based respiratory rate (RR) using a pulse oximeter (Masimo Rad-G) by comparing it with a gold standard (pediatrician) measurement. Study design A cross sectional study was conducted in the OPD and emergency ward of Kalawati Saran Children’s Hospital over a 2 week period wherein a convenience sample of 97 children (2 to 59 months) were assessed by a pediatrician as part of routine assessment alongside independent measure by a consultant using pulse oximeter. The level of agreement between plethymography based RR and pediatrician measure was analyzed along with sensitivity and specificity of fast breathing of plethymography based RR measure. Results Both methods of measurement show strong association (97%, p < 0.001) and observed values, falling on line of unity, obtained either from pulse oximeter or by pediatrician are very close to each other. Fast breathing measured by POx has a sensitivity of 95% and specificity of nearly 94%. Conclusion The current study provides evidence of the accuracy of a plethysmography based RR using a pulse oximeter which can potentially be of use in planning of pneumonia management in public health facilities.
Collapse
|
22
|
Shittu F, Agwai IC, Falade AG, Bakare AA, Graham H, Iuliano A, Aranda Z, McCollum ED, Isah A, Bahiru S, Ahmed T, Burgess RA, King C, Colbourn T, On Behalf Of The Inspiring Project Consortium. Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S78-S90. [PMID: 31990146 PMCID: PMC7977681 DOI: 10.1002/ppul.24660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Case fatality rates for childhood pneumonia in Nigeria remain high. There is a clear need for improved case management of pneumonia, through the sustainable implementation of the Integrated Management of Childhood Illnesses (IMCI) diagnostic and treatment algorithms. We explored barriers and opportunities for improved case management of childhood pneumonia in Lagos and Jigawa states, Nigeria. METHODS A mixed-method analysis was conducted to assess the current health system capacity to deliver quality care. This was done through audits of 16 facilities in Jigawa and 14 facilities in Lagos, questionnaires (n = 164) and 13 focus group discussions with providers. Field observations provided context for data analysis and triangulation. RESULTS There were more private providers in Lagos (4/8 secondary facilities) and more government providers in Jigawa (4/8 primary, 3/3 secondary, and 1/1 tertiary facilities). Oxygen and pulse oximeters were available in two of three in Jigawa and six of eight in Lagos of the sampled secondary care facilities. None of the eight primary facilities surveyed in Jigawa had oxygen or pulse oximetry available while in Lagos two of three primary facilities had oxygen and one of three had pulse oximeters. Other IMCI and emergency equipment were also lacking including respiratory rate timers, particularly in Jigawa state. Health care providers scored poorly on knowledge of IMCI, though previous IMCI training was associated with better knowledge. Key enabling factors in delivering pediatric care highlighted by health care providers included accountability procedures and feedback loops, the provision of free medication for children, and philanthropic acts. Common barriers to provide care included the burden of out-of-pocket payments, challenges in effective communication with caregivers, delayed presentation, and lack of clear diagnosis, and case management guidelines. CONCLUSION There is an urgent need to improve how the prevention and treatment of pediatric pneumonia is directed in both Lagos and Jigawa. Priority areas for reducing pediatric pneumonia burden are training and mentoring of health care providers, community health education, and introduction of oximeters and oxygen supply.
Collapse
Affiliation(s)
- Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Hamish Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | | | | | | | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | | |
Collapse
|
23
|
Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso. Malar J 2020; 19:118. [PMID: 32192499 PMCID: PMC7082958 DOI: 10.1186/s12936-020-03191-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Seasonal malaria chemoprevention (SMC) relies on community health workers to distribute drugs. This study assessed: (1) the capacity of community-based distributors (CBDs) at the start and end of a campaign and from one campaign to another after training or refresher courses before each round; (2) to what extent CBDs’ experience over several campaigns contributed to measurable increase in their capacities; and (3) to what extent the training and experience of committed CBDs helped the less productive to catch up. Methods A longitudinal analysis was conducted in one Burkina Faso health district during the 2017 and 2018 campaigns. A panel including all CBDs was created. Their capacities were observed after: (1) initial training for the 2017 season; (2) refresher training for that year’s fourth round; and (3) initial training for the 2018 season. All were invited to complete a questionnaire at the end of training with 27 multiple-choice questions on their main tasks. Observers noted content coverage and conditions under which training sessions were conducted. Results The 612 CBDs showed, on average, high understanding of their tasks from the start of the annual campaigns. Tasks related to communicating with parents and reporting were best mastered. Their capacities grew from round to round and campaign to campaign, after most had undergone training and been supervised by head nurses. The greatest progress was in the technical components, considered more complex, which involved selecting eligible children, choosing the correct drug packet, and referring children to health professionals. Retaining CBDs from one round to the next benefited everyone, whatever their starting level. Groups that initially obtained the lowest scores (women, illiterates, youngest/oldest) progressed the most. Conclusion These results confirm the potential of using CBDs under routine programme implementation. Mandating CBDs with targeted tasks is a functional model, as they achieve mastery in this context where investments are made in training and supervision. Losing this specificity by extending CBDs’ mandates beyond SMC could have undesirable consequences. The added value of retaining committed CBDs is high. It is suggested that motivation and commitment be considered in recruitment, and that a supportive climate be created to foster retention.
Collapse
|
24
|
Assessment of Factors Affecting the Implementation of Integrated Management of Neonatal and Childhood Illness for Treatment of under Five Children by Health Professional in Health Care Facilities in Yifat Cluster in North Shewa Zone, Amhara Region, Ethiopia. Int J Pediatr 2020; 2019:9474612. [PMID: 31949443 PMCID: PMC6948312 DOI: 10.1155/2019/9474612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023] Open
Abstract
Background Every year some 12 million children in developing countries die before they reach their fifth birthday. Seven in ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria or malnutrition. The WHO Department of Child and Adolescent Health and Development (CAH), in collaboration with eleven other WHO programmes and UNICEF, has responded to this challenge by developing the Integrated Management of Childhood Illness (IMCI) strategy. Research that examines assessment of factors influencing the implementing the integrated management of neonatal and childhood illnesses (IMCI) strategy in Ethiopia is limited. Objective To assess factors influencing the implementation of the IMNCI strategy by health professionals in public health institutions of Yifat cluster in North Shewa zone, Ethiopia, 2018. Method An institutional based cross-sectional study will be conducted from March to May. A total of 201 health professionals will be selected using proportionally allocated to population size and interviewed using structured and pretested questionnaires. Data will be coded, entered and cleaned using SPSS version 20 for analysis. Univariate (frequency), Bivariate, Multiple logistic regression analysis will be employed. P-value and 95% confidence interval (CI) for OR will be used in judging the significance of the associations. P-value less than 0.05 will be taken as significant association. Results Data were obtained from 201 health care professionals, yielding a response rate of 100%. The overall IMNCI implementation was 58% as high level implementation and 42% as low level implementation. In multivariate analysis the implementation of IMNCI was higher among IMNCI trained health care professionals ([AOR = 2.7, 95% CI: (1.1.278, 4.562)]) and among those whose always referring chart booklet [AOR = 2.76, 95% CI: (1.753, 5.975)]. Conclusion IMNCI strategy can be better implemented through provision of training for the health workers. However, a variety of factor found to be a barrier to IMNCI implementation in a consistent way. Recommendations have been made related to provision of the training to the nurses and Health Care system strengthening among others.
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Lubell Y, Chandna A, Smithuis F, White L, Wertheim HFL, Redard-Jacot M, Katz Z, Dondorp A, Day N, White N, Dittrich S. Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity. Malar J 2019; 18:442. [PMID: 31878978 PMCID: PMC6933672 DOI: 10.1186/s12936-019-3059-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022] Open
Abstract
Malaria is no longer a common cause of febrile illness in many regions of the tropics. In part, this success is a result of improved access to accurate diagnosis and effective anti-malarial treatment, including in many hard-to-reach rural areas. However, in these settings, management of other causes of febrile illness remains challenging. Health systems are often weak and other than malaria rapid tests no other diagnostics are available. With millions of deaths occurring annually due to treatable bacterial infections and the ever increasing spread of antimicrobial resistance, improvement in the management of febrile illness is a global public health priority. Whilst numerous promising point-of-care diagnostics are in the pipeline, substantial progress can be made in the interim with existing tools: C-reactive protein (CRP) is a highly sensitive and moderately specific biomarker of bacterial infection and has been in clinical use for these purposes for decades, with dozens of low-cost devices commercially available. This paper takes a health-economics approach to consider the possible advantages of CRP point-of-care tests alongside rapid diagnostic tests for malaria, potentially in a single multiplex device, to guide antimicrobial therapy for patients with febrile illness. Three rudimentary assessments of the costs and benefits of this approach all indicate that this is likely to be cost-effective when considering the incremental costs of the CRP tests as compared with either (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns in areas of low transmission. While CRP-guided antibiotic therapy alone cannot resolve all challenges associated with management of febrile illness in remote tropical settings, in the short-term a multiplexed CRP and malaria RDT could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs. These findings should spark further interest amongst industry, academics and policy-makers in the development and deployment of such diagnostics, and discussion on their geographically appropriate use.
Collapse
Affiliation(s)
- Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Arjun Chandna
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Frank Smithuis
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Lisa White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Heiman F L Wertheim
- Department of Medical Microbiology, Medical Center for Infectious Diseases, Radboud University, Radboudumc, Nijmegen, The Netherlands
| | - Maël Redard-Jacot
- Foundation of Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Zachary Katz
- Foundation of Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sabine Dittrich
- Foundation of Innovative New Diagnostics (FIND), Geneva, Switzerland
| |
Collapse
|
27
|
Clarke-Deelder E, Shapira G, Samaha H, Fritsche GB, Fink G. Quality of care for children with severe disease in the Democratic Republic of the Congo. BMC Public Health 2019; 19:1608. [PMID: 31791291 PMCID: PMC6889659 DOI: 10.1186/s12889-019-7853-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC). METHODS One thousand one hundred eighty under-five clinical visits were observed across a regionally representative sample of 321 facilities in the DRC. Based on a detailed list of disease symptoms observed, patients with severe febrile disease (including malaria), severe pneumonia, and severe dehydration were identified. For all three disease categories, treatments were then compared to recommended case management following IMCI guidelines. RESULTS Out of 1180 under-five consultations observed, 332 patients (28%) had signs of severe febrile disease, 189 patients (16%) had signs of severe pneumonia, and 19 patients (2%) had signs of severe dehydration. Overall, providers gave the IMCI-recommended treatment in 42% of cases of these three severe diseases. Less than 15% of children with severe disease were recommended to receive in-patient care either in the facility they visited or in a higher-level facility. CONCLUSIONS These results suggest that adherence to IMCI protocols for severe disease remains remarkably low in the DRC. There is a critical need to identify and implement effective approaches for improving the quality of care for severely ill children in settings with high child mortality.
Collapse
Affiliation(s)
| | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Socinstrasse 57, 4051, Basel, Switzerland.
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Amoakoh-Coleman M, Ansah E, Klipstein-Grobusch K, Arhinful D. Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods. BMJ Open 2019; 9:e029785. [PMID: 31519675 PMCID: PMC6747881 DOI: 10.1136/bmjopen-2019-029785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the completeness of obstetric referral letters/notes at the district level of healthcare. DESIGN An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data. SETTING Three (3) districts in the Greater Accra region of Ghana. PARTICIPANTS Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses. INTERVENTION An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms. OUTCOME Completeness of obstetric referral letters/notes. RESULTS Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons. CONCLUSIONS Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
Collapse
Affiliation(s)
- Mary Amoakoh-Coleman
- Department of Epidemiology, University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Evelyn Ansah
- Center for Malaria Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Biostatistics and Epidemiology, School of Public Health, Wits University, Johannesburg-Braamfontein, South Africa
| | - Daniel Arhinful
- Department of Epidemiology, University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| |
Collapse
|
30
|
Meaney PA, Joyce CL, Setlhare S, Smith HE, Mensinger JL, Zhang B, Kalenga K, Kloeck D, Kgosiesele T, Jibril H, Mazhani L, de Caen A, Steenhoff AP. Knowledge acquisition and retention following Saving Children's Lives course for healthcare providers in Botswana: a longitudinal cohort study. BMJ Open 2019; 9:e029575. [PMID: 31420392 PMCID: PMC6701641 DOI: 10.1136/bmjopen-2019-029575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Millions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children's Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers. SETTING 76 participating centres who provide primary and secondary care in Kweneng District, Botswana. PARTICIPANTS Doctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment. METHODS Retrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study. RESULTS 211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p<0.0001), and loss of retention was observed (-1.60±0.67/month, p=0.018). IMCI training demonstrated no significant effect on acquisition (+3.58±2.84, p=0.211 or retention (+0.20±0.91/month, p=0.824) of knowledge. On average, nurses scored lower than physicians (-19.39±3.30, p<0.0001). Lost to follow-up had a significant impact on knowledge retention (-3.03±0.88/month, p=0.0007). CONCLUSIONS aHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.
Collapse
Affiliation(s)
- Peter Andrew Meaney
- Pediatrics, Stanford University, Stanford, California, USA
- Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Christine Lynn Joyce
- Critical Care, Cornell University Department of Pediatrics, New York, New York, USA
| | - Segolame Setlhare
- Helping Children Survive, American Heart Association Inc, Gaborone, Gaborone, Botswana
| | - Hannah E Smith
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bingqing Zhang
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kitenge Kalenga
- Kweneng District Health Management Team, Molepolole, Kweneng, Botswana
| | - David Kloeck
- Critical Care, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Thandie Kgosiesele
- Clinical Services, Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Haruna Jibril
- Clinical Services, Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Loeto Mazhani
- Pediatrics, University of Botswana Faculty of Health Sciences, Gaborone, Gaborone, Botswana
| | - Allan de Caen
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew P Steenhoff
- Infectious Diseases, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
31
|
Integrated Management of Newborn and Childhood Illness (IMNCI) Strategy and its Implementation in Real Life Situation. Indian J Pediatr 2019; 86:622-627. [PMID: 30778951 DOI: 10.1007/s12098-019-02870-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
To meet the sustainable development goals (SDG) target of reducing under-five mortality to 25 per 1000 live births, concerted efforts are required to end all preventable deaths of newborns and children under 5 y of age. There is evidence to support Integrated Management of Neonatal and Childhood Illness (IMNCI) as a cost- effective strategy which can improve child survival. IMNCI has 3 components- capacity building of health workers, health system strengthening and improving community and family practice. For best results, all three components of the IMNCI strategy should be implemented in a coordinated fashion. IMNCI implementation in india has been uneven. The main focus has been on capacity building and with little attention on system strengthening or improving community practices. Ill- sustained funding and poor monitoring and supervision system were additional factors which are major challenges. Since evidence based interventions remain same, IMNCI remains as relevant today as before. It would be appropriate to redesign it as per current needs and implement it with more planning with committed budget and inbuilt measures of quality improvement along with supportive supervision.
Collapse
|
32
|
Treatment by untrained providers among sick infants in rural Odisha, India. Prim Health Care Res Dev 2019; 20:e84. [PMID: 32800006 PMCID: PMC7306414 DOI: 10.1017/s1463423619000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants. Background: In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice. Method: A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form – designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers. Findings: A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics – cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.
Collapse
|
33
|
A systematic review of the effectiveness of strategies to improve health care provider performance in low- and middle-income countries: Methods and descriptive results. PLoS One 2019; 14:e0217617. [PMID: 31150458 PMCID: PMC6544255 DOI: 10.1371/journal.pone.0217617] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health care provider (HCP) performance in low- and middle-income countries (LMICs) is often inadequate. The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of the effectiveness and cost of strategies to improve HCP performance in LMICs. We present the HCPPR's methods, describe methodological and contextual attributes of included studies, and examine time trends of study attributes. METHODS The HCPPR includes studies from LMICs that quantitatively evaluated any strategy to improve HCP performance for any health condition, with no language restrictions. Eligible study designs were controlled trials and interrupted time series. In 2006, we searched 15 databases for published studies; in 2008 and 2010, we completed searches of 30 document inventories for unpublished studies. Data from eligible reports were double-abstracted and entered into a database, which is publicly available. The primary outcome measure was the strategy's effect size. We assessed time trends with logistic, Poisson, and negative binomial regression modeling. We were unable to register with PROSPERO (International Prospective Register of Systematic Reviews) because the protocol was developed prior to the PROSPERO launch. RESULTS We screened 105,299 citations and included 824 reports from 499 studies of 161 intervention strategies. Most strategies had multiple components and were tested by only one study each. Studies were from 79 countries and had diverse methodologies, geographic settings, HCP types, work environments, and health conditions. Training, supervision, and patient and community supports were the most commonly evaluated strategy components. Only 33.6% of studies had a low or moderate risk of bias. From 1958-2003, the number of studies per year and study quality increased significantly over time, as did the proportion of studies from low-income countries. Only 36.3% of studies reported information on strategy cost or cost-effectiveness. CONCLUSIONS Studies have reported on the efficacy of many strategies to improve HCP performance in LMICs. However, most studies have important methodological limitations. The HCPPR is a publicly accessible resource for decision-makers, researchers, and others interested in improving HCP performance.
Collapse
|
34
|
Rhee C, Aol G, Ouma A, Audi A, Muema S, Auko J, Omore R, Odongo G, Wiegand RE, Montgomery JM, Widdowson MA, O'Reilly CE, Bigogo G, Verani JR. Inappropriate use of antibiotics for childhood diarrhea case management - Kenya, 2009-2016. BMC Public Health 2019; 19:468. [PMID: 32326936 PMCID: PMC6696675 DOI: 10.1186/s12889-019-6771-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Antibiotics are essential to treat for many childhood bacterial infections; however inappropriate antibiotic use contributes to antimicrobial resistance. For childhood diarrhea, empiric antibiotic use is recommended for dysentery (bloody diarrhea) for which first-line therapy is ciprofloxacin. We assessed inappropriate antibiotic prescription for childhood diarrhea in two primary healthcare facilities in Kenya. METHODS We analyzed data from the Kenya Population Based Infectious Disease Surveillance system in Asembo (rural, malaria-endemic) and Kibera (urban slum, non-malaria-endemic). We examined records of children aged 2-59 months with diarrhea (≥3 loose stools in 24 h) presenting for care from August 21, 2009 to May 3, 2016, excluding visits with non-diarrheal indications for antibiotics. We examined the frequency of antibiotic over-prescription (antibiotic prescription for non-dysentery), under-prescription (no antibiotic prescription for dysentery), and inappropriate antibiotic selection (non-recommended antibiotic). We examined factors associated with over-prescription and under-prescription using multivariate logistic regression with generalized estimating equations. RESULTS Of 2808 clinic visits with diarrhea in Asembo, 2685 (95.6%) were non-dysentery visits and antibiotic over-prescription occurred in 52.5%. Of 4697 clinic visits with diarrhea in Kibera, 4518 (96.2%) were non-dysentery and antibiotic over-prescription occurred in 20.0%. Antibiotic under-prescription was noted in 26.8 and 73.7% of dysentery cases in Asembo and Kibera, respectively. Ciprofloxacin was used for 11% of dysentery visits in Asembo and 0% in Kibera. Factors associated with over- and under-prescription varied by site. In Asembo a discharge diagnosis of gastroenteritis was associated with over-prescription (adjusted odds ratio [aOR]:8.23, 95% confidence interval [95%CI]: 3.68-18.4), while malaria diagnosis was negatively associated with antibiotic over-prescription (aOR 0.37, 95%CI: 0.25-0.54) but positively associated with antibiotic under-prescription (aOR: 1.82, 95%CI: 1.05-3.13). In Kibera, over-prescription was more common among visits with concurrent signs of respiratory infection (difficulty breathing; aOR: 3.97, 95%CI: 1.28-12.30, cough: aOR: 1.42, 95%CI: 1.06-1.90) and less common among children aged < 1 year (aOR: 0.82, 95%CI: 0.71-0.94). CONCLUSIONS Inappropriate antibiotic prescription was common in childhood diarrhea management and efforts are needed to promote rational antibiotic use. Interventions to improve antibiotic use for diarrhea should consider the influence of malaria diagnosis on clinical decision-making and address both over-prescription, under-prescription, and inappropriate antibiotic selection.
Collapse
Affiliation(s)
- Chulwoo Rhee
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - George Aol
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Shadrack Muema
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joshua Auko
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Richard Omore
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - George Odongo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan E Wiegand
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| |
Collapse
|
35
|
Kufe NC, Metekoua C, Nelly M, Tumasang F, Mbu ER. Retention of health care workers at health facility, trends in the retention of knowledge and correlates at 3rd year following training of health care workers on the prevention of mother-to-child transmission (PMTCT) of HIV-National Assessment. BMC Health Serv Res 2019; 19:78. [PMID: 30696489 PMCID: PMC6352341 DOI: 10.1186/s12913-019-3925-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledgeable Health Care Workers (HCWs) are indispensable for the proper management of clients. We investigated retention of HCWs at health facility and retention of knowledge at 18, 24 and 36 months after training and correlates for retention of knowledge at 3rd year. METHODS A cross-sectional study was conducted among 1000 HCWs, 710 were trained and 290 untrained working at the PMTCT of HIV services in health facilities of the ten regions of Cameroon. A Multiple Choice Questionnaire (MCQ) on HIV management with focus on PMTCT of HIV was used to assess retention of HCWs at the health facility and retention of knowledge. Summary statistics described mean scores for retention of HCWs and retention of knowledge. One-way Analysis of Variance summarized the differences in retention of knowledge over time after training. Correlates for retention of knowledge were investigated by logistic regression analysis. RESULTS The retention of HCWs at health facilities in PMTCT of HIV services was 85%. Trained HCWs had higher mean scores for retention of knowledge than untrained HCWs, p < 0.001. Knowledge attrition was observed from 18, 24 to 36 months following training. Differences in the mean scores for retention of knowledge were observed between state-owned with private and confessionary health facilities but not among trained HCWs at 18, 24 or 36 months. Highest mean scores for retention of knowledge were observed in District Hospitals, Sub-Divisional Hospitals, and Integrated Health Centres. Correlates for retention of knowledge were: gender, type of health facility, location, longevity at PMTCT services, trained others and had means to apply what was trained to do. CONCLUSION Retention of trained HCWs at health facilities was high, mean scores for retention of knowledge was average and knowledge attrition was observed over time. This research is critical to understand where interventions may be most effective.
Collapse
Affiliation(s)
- Nyuyki Clement Kufe
- Medical Research Council (MRC)/Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Global Health Metrics (GHM) Research Group, BO Box 8111, Yaoundé, Cameroon.
| | - Carole Metekoua
- Global Health Metrics (GHM) Research Group, BO Box 8111, Yaoundé, Cameroon.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Monkam Nelly
- Department of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| | - Florence Tumasang
- Department of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| | - Enow Robinson Mbu
- Department of Family Health, Ministry of Public Health, Yaoundé, Cameroon
| |
Collapse
|
36
|
Robertson SK, Manson K, Fioratou E. IMCI and ETAT integration at a primary healthcare facility in Malawi: a human factors approach. BMC Health Serv Res 2018; 18:1014. [PMID: 30594185 PMCID: PMC6310991 DOI: 10.1186/s12913-018-3803-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach. METHOD Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. Along with observations from the clinic this provided a well-rounded view of the running of the clinic. This data was then analysed using the SEIPS 2.0 work systems framework. The work system elements specified in this model were used to identify and categorise themes that influenced the clinic's efficiency. RESULTS A process map of the flow of patients through the clinic was created, showing the tasks undertaken and the interactions between staff and patients. In their interviews, staff identified several organisational elements that served as barriers to the implementation of care. They included workload, available resources, ineffective time management, delegation of roles and adaptation of care. In terms of the external environment there was a lack of clarity over the two sets of guidelines and how they were to be integrated which was a key barrier to the process. Under the heading of tools and technology a lack of guideline copies was identified as a barrier. However, the health passport system and other forms of recording were highlighted as being important facilitators. Other issues highlighted were the lack of transport provided, challenges regarding teamwork and attitudes of members of staff, patient factors such as their beliefs and regard for the care and education provided by the clinic. CONCLUSIONS This study provides the first information on the challenges and issues involved in combining IMCI and ETAT and identified a number of barriers. These barriers included a lack of resources, staff training and heavy workload. This provided areas to work on in order to improve implementation.
Collapse
|
37
|
Rowe AK, Rowe SY, Peters DH, Holloway KA, Chalker J, Ross-Degnan D. Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review. LANCET GLOBAL HEALTH 2018; 6:e1163-e1175. [PMID: 30309799 PMCID: PMC6185992 DOI: 10.1016/s2214-109x(18)30398-x] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 11/09/2022]
Abstract
Background Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs. Methods For this systematic review we searched 52 electronic databases for published studies and 58 document inventories for unpublished studies from the 1960s to 2016. Eligible study designs were controlled trials and interrupted time series. We only included strategy-versus-control group comparisons. We present results of improving health-care provider practice outcomes expressed as percentages (eg, percentage of patients treated correctly) or as continuous measures (eg, number of medicines prescribed per patient). Effect sizes were calculated as absolute percentage-point changes. The summary measure for each comparison was the median effect size (MES) for all primary outcomes. Strategy effectiveness was described with weighted medians of MES. This study is registered with PROSPERO, number CRD42016046154. Findings We screened 216 477 citations and selected 670 reports from 337 studies of 118 strategies. Most strategies had multiple intervention components. For professional health-care providers (generally, facility-based health workers), the effects were near zero for only implementing a technology-based strategy (median MES 1·0 percentage points, IQR −2·8 to 9·9) or only providing printed information for health-care providers (1·4 percentage points, −4·8 to 6·2). For percentage outcomes, training or supervision alone typically had moderate effects (10·3–15·9 percentage points), whereas combining training and supervision had somewhat larger effects than use of either strategy alone (18·0–18·8 percentage points). Group problem solving alone showed large improvements in percentage outcomes (28·0–37·5 percentage points), but, when the strategy definition was broadened to include group problem solving alone or other strategy components, moderate effects were more typical (12·1 percentage points). Several multifaceted strategies had large effects, but multifaceted strategies were not always more effective than simpler ones. For lay health-care providers (generally, community health workers), the effect of training alone was small (2·4 percentage points). Strategies with larger effect sizes included community support plus health-care provider training (8·2–125·0 percentage points). Contextual and methodological heterogeneity made comparisons difficult, and most strategies had low quality evidence. Interpretation The impact of strategies to improve health-care provider practices varied substantially, although some approaches were more consistently effective than others. The breadth of the HCPPR makes its results valuable to decision makers for informing the selection of strategies to improve health-care provider practices in LMICs. These results also emphasise the need for researchers to use better methods to study the effectiveness of interventions. Funding Bill & Melinda Gates Foundation, CDC Foundation.
Collapse
Affiliation(s)
- Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Samantha Y Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; CDC Foundation, Atlanta, GA, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen A Holloway
- World Health Organization, Southeast Asia Regional Office, New Delhi, India; International Institute of Health Management Research, Jaipur, India; Institute of Development Studies, University of Sussex, Brighton, UK
| | - John Chalker
- Pharmaceuticals & Health Technologies Group, Management Sciences for Health, Arlington, VA, USA
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| |
Collapse
|
38
|
Unicomb L, Begum F, Leontsini E, Rahman M, Ashraf S, Naser AM, Nizame FA, Jannat K, Hussain F, Parvez SM, Arman S, Mobashara M, Luby SP, Winch PJ. WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial. Trials 2018; 19:359. [PMID: 29976247 PMCID: PMC6034218 DOI: 10.1186/s13063-018-2709-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/25/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) efficacy trials deliver interventions to the target population under optimal conditions to estimate their effects on outcomes of interest, to inform subsequent selection for inclusion in routine programs. A systematic and intensive approach to intervention delivery is required to achieve the high-level uptake necessary to measure efficacy. We describe the intervention delivery system adopted in the WASH Benefits Bangladesh study, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance. METHODS Community Health Workers (CHWs) delivered individual and combined WASH and nutrition interventions to 4169 enrolled households in geographically matched clusters. Households were provided with free enabling technologies and supplies, integrated with parallel behaviour-change promotion. Behavioural objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviours (birth to 24 months). The intervention delivery system built on lessons learned from prior WASH intervention effectiveness, implementation, and formative research studies. We recruited local CHWs, residents of the study villages, through transparent merit-based selection methods, and consultation with community leaders. CHW supervisors received training on direct intervention delivery, then trained their assigned CHWs. CHWs in turn used the technologies in their own homes. Each CHW counseled six to eight intervention households spread across a 0.2-2.2-km radius, with a 1:12 supervisor-to-CHW ratio. CHWs met monthly with supervisor-trainers to exchange experiences and adapt technology and behaviour-change approaches to evolving conditions. Intervention uptake was tracked through fidelity measures, with a priori benchmarks necessary for an efficacy study. RESULTS Sufficient levels of uptake were attained by the fourth intervention assessment month and sustained throughout the intervention period. Periodic internal CHW monitoring resulted in discontinuation of a small number of low performers. CONCLUSIONS The intensive intervention delivery system required for an efficacy trial differs in many respects from the system for a routine program. To implement a routine program at scale requires further research on how to optimize the supervisor-to-CHW-to-intervention household ratios, as well as other program costs without compromising program effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCC01590095 . Registered on 2 May 2012.
Collapse
Affiliation(s)
- Leanne Unicomb
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Farzana Begum
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Elli Leontsini
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Mahbubur Rahman
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sania Ashraf
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Abu Mohd Naser
- Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Fosiul A. Nizame
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kaniz Jannat
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Faruqe Hussain
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sarker Masud Parvez
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Shaila Arman
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Moshammot Mobashara
- Infectious Disease Division, Environmental Intervention Unit, Enteric and Respiratory Disease Program, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Peter J. Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| |
Collapse
|
39
|
Sumaila AN, Tabong PTN. Rational prescribing of antibiotics in children under 5 years with upper respiratory tract infections in Kintampo Municipal Hospital in Brong Ahafo Region of Ghana. BMC Res Notes 2018; 11:443. [PMID: 29973249 PMCID: PMC6031134 DOI: 10.1186/s13104-018-3542-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the rational use of antibiotics in children with URTIs in the Kintampo Municipal Hospital in Ghana. RESULTS A total of 839 medicines were prescribed, 237 were antibiotics. The mean number of medicines prescribed per patient encounter was 3.1. The percentage of patient encounters with antibiotics was 28.2 and 0.4% for injections. The percentage of medicines prescribed by generic was 93.8% and from the essential medicines list was 94.9%. Ninety-two of patients received amoxicillin. Polypharmacy was common as prescriptions with five to six medicines per patient encounter was found. Some prescribers are not following the WHO/INRUD requirement of prescribing medicines in their generic and from the essential medicine list of the country.
Collapse
Affiliation(s)
- Abdul-Nasiru Sumaila
- Pharmacy Department, Jema District Hospital, Ghana Health Services, Accra, Brong Ahafo Region Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
40
|
Koulidiati JL, Nesbitt RC, Ouedraogo N, Hien H, Robyn PJ, Compaoré P, Souares A, Brenner S. Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study. BMJ Open 2018; 8:e020423. [PMID: 29858415 PMCID: PMC5988102 DOI: 10.1136/bmjopen-2017-020423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/26/2018] [Accepted: 03/05/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. METHODS We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities' catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. RESULTS Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. CONCLUSION Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage.
Collapse
Affiliation(s)
| | - Robin C Nesbitt
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Nobila Ouedraogo
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Hervé Hien
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
- Institut de recherche en science de la santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | | | | | - Aurélia Souares
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Stephan Brenner
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
41
|
Uwemedimo OT, Lewis TP, Essien EA, Chan GJ, Nsona H, Kruk ME, Leslie HH. Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi. BMJ Glob Health 2018; 3:e000506. [PMID: 29662688 PMCID: PMC5898357 DOI: 10.1136/bmjgh-2017-000506] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/01/2022] Open
Abstract
Background Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi. Methods Data were obtained from the 2013-2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity. Results 3136 clinical visits for children 2-59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity. Conclusions Care quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.
Collapse
Affiliation(s)
- Omolara T Uwemedimo
- Department of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell GLOhBAL (Global Learning. Optimizing health. Building Alliances Locally), Hempstead, New York, USA
| | - Todd P Lewis
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, New York, USA
| | - Elsie A Essien
- GLOhBAL (Global Learning. Optimizing health. Building Alliances Locally) at Cohen, Children's Medical Center, New Hyde Park, New York, USA
| | - Grace J Chan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, New York, USA
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, New York, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, New York, USA
| |
Collapse
|
42
|
Johansson EW, Nsona H, Carvajal-Aguirre L, Amouzou A, Hildenwall H. Determinants of Integrated Management of Childhood Illness (IMCI) non-severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census. J Glob Health 2018; 7:020408. [PMID: 29163934 PMCID: PMC5680530 DOI: 10.7189/jogh.07.020408] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Research shows inadequate Integrated Management of Childhood Illness (IMCI)-pneumonia care in various low-income settings but evidence is largely from small-scale studies with limited evidence of patient-, provider- and facility-levels determinants of IMCI non-severe pneumonia classification and its management. Methods The Malawi Service Provision Assessment 2013-2014 included 3149 outpatients aged 2-59 months with completed observations, interviews and re-examinations. Mixed-effects logistic regression models quantified the influence of patient-, provider and facility-level determinants on having IMCI non-severe pneumonia and its management in observed consultations. Findings Among 3149 eligible outpatients, 590 (18.7%) had IMCI non-severe pneumonia classification in re-examination. 228 (38.7%) classified cases received first-line antibiotics and 159 (26.9%) received no antibiotics. 18.6% with cough or difficult breathing had 60-second respiratory rates counted during consultations, and conducting this assessment was significantly associated with IMCI training ever received (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.29-4.31) and negative rapid diagnostic test results (OR = 3.21, 95% CI: 1.45-7.13). Older children had lower odds of assessments than infants (OR = 48-59 months: 0.35, 95% CI: 0.16-0.75). Children presenting with any of the following complaints also had reduced odds of assessment: fever, diarrhea, skin problem or any danger sign. First-line antibiotic treatment for classified cases was significantly associated with high temperatures (OR = 3.26, 95% CI: 1.24-8.55) while older children had reduced odds of first-line treatment compared to infants (OR = 48-59 months: 0.29, 95% CI: 0.10-0.83). RDT-confirmed malaria was a significant predictor of no antibiotic receipt for IMCI non-severe pneumonia (OR = 10.65, 95% CI: 2.39-47.36). Conclusions IMCI non-severe pneumonia care was sub-optimal in Malawi health facilities in 2013-2014 with inadequate assessments and prescribing practices that must be addressed to reduce this leading cause of mortality. Child's symptoms and age, malaria diagnosis and provider training were primary influences on assessment and treatment practices. Current evidence could be used to better target IMCI training and support to improve pneumonia care for sick children in Malawi facilities.
Collapse
Affiliation(s)
| | - Humphreys Nsona
- Integrated Management of Childhood Illness (IMCI) Unit, Ministry of Health, Lilongwe, Malawi
| | | | - Agbessi Amouzou
- Data and Analytics Section, United Nations Children's Fund, New York, New York, USA
| | - Helena Hildenwall
- Global Health - Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
43
|
Aggarwal AK, Gupta R, Das D, Dhakar AS, Sharma G, Anand H, Kaur K, Sheoran K, Dalpath S, Khatri J, Gupta M. An Alternative Approach for Supportive Supervision and Skill Measurements of Health Workers for Integrated Management of Neonatal and Childhood Illnesses Program in 10 Districts of Haryana. Indian J Community Med 2018. [PMID: 29531438 PMCID: PMC5842473 DOI: 10.4103/ijcm.ijcm_402_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Context: “Integrated Management of Neonatal and Childhood Illnesses” (IMNCI) needs regular supportive supervision (SS). Aims: The aim of this study was to find suitable SS model for implementing IMNCI. Settings and Design: This was a prospective interventional study in 10 high-focus districts of Haryana. Subjects and Methods: Two methods of SS were used: (a) visit to subcenters and home visits (model 1) and (b) organization of IMNCI clinics/camps at primary health center (PHC) and community health center (CHC) (model 2). Skill scores were measured at different time points. Routine IMNCI data from study block and randomly selected control block of each district were retrieved for 4 months before and after the training and supervision. Statistical Analysis Used: Change in percentage mean skill score difference and percentage difference in median number of children were assessed in two areas. Results: Mean skill scores increased significantly from 2.1 (pretest) to 7.0 (posttest 1). Supportive supervisory visits sustained and improved skill scores. While model 2 of SS could positively involve health system officials, model 1 was not well received. Outcome indicator in terms of number of children assessed showed a significant improvement in intervention areas. Conclusions: SS in IMNCI clinics/camps at PHC/CHC level and innovative skill scoring method is a promising approach.
Collapse
Affiliation(s)
- Arun K Aggarwal
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Gupta
- National Health Mission, Panchkula, Haryana, India
| | - Dhritiman Das
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anar S Dhakar
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gourav Sharma
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himani Anand
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalpreet Kaur
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Sheoran
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Madhu Gupta
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
44
|
Leslie HH, Gage A, Nsona H, Hirschhorn LR, Kruk ME. Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa. Health Aff (Millwood) 2018; 35:1716-24. [PMID: 27605655 DOI: 10.1377/hlthaff.2016.0261] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.
Collapse
Affiliation(s)
- Hannah H Leslie
- Hannah H. Leslie is a postdoctoral fellow in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Anna Gage
- Anna Gage is a visiting scientist at the Harvard T. H. Chan School of Public Health
| | - Humphreys Nsona
- Humphreys Nsona is program manager of the Integrated Management of Childhood Illness Unit in the Ministry of Health, in Lilongwe, Malawi
| | - Lisa R Hirschhorn
- Lisa R. Hirschhorn is director of the implementation and improvement sciences platform at Ariadne Labs and an associate professor of medicine in the Department of Global Health and Social Medicine at Harvard Medical School, both in Boston
| | - Margaret E Kruk
- Margaret E. Kruk is an associate professor of global health in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health
| |
Collapse
|
45
|
Shilkofski N, Crichlow A, Rice J, Cope L, Kyaw YM, Mon T, Kiguli S, Jung J. A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings. Front Pediatr 2018; 6:37. [PMID: 29600241 PMCID: PMC5863499 DOI: 10.3389/fped.2018.00037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/09/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Under five mortality rates (UFMR) remain high for children in low- and middle-income countries (LMICs) in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities). In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO) has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal. MATERIALS AND METHODS The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation. RESULTS Infectious diseases (respiratory illnesses and diarrheal disease) were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations. DISCUSSION AND CONCLUSION Epidemiology of disease burden reported by respondents was relatively consistent with WHO country-specific UFMR statistics in each setting. Results of the needs assessment survey were subsequently used to refine goals and objectives for the simulation curriculum and to ensure delivery of pragmatic educational content with recommendations that were contextualized for local capacity and resource availability. Effective use of the tool in two different settings increases its potential generalizability.
Collapse
Affiliation(s)
- Nicole Shilkofski
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amanda Crichlow
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Julie Rice
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leslie Cope
- Department of Oncology, Johns Hopkins University School of Medicine, Division of Bioinformatics and Biostatistics, Baltimore, MD, United States
| | - Ye Myint Kyaw
- Head of Department of Pediatrics, University of Medicine 1 Yangon, Yangon Children's Hospital, Yangon, Myanmar
| | - Thazin Mon
- Department of Pediatrics, University of Medicine 2 Yangon, Yangon Children's Hospital, Yangon, Myanmar
| | - Sarah Kiguli
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julianna Jung
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Vasan A, Mabey DC, Chaudhri S, Brown Epstein HA, Lawn SD. Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods. Health Policy Plan 2017; 32:437-452. [PMID: 27993961 PMCID: PMC5400115 DOI: 10.1093/heapol/czw144] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/16/2022] Open
Abstract
Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.
Collapse
Affiliation(s)
- Ashwin Vasan
- Department of Population and Family Health & Department of Medicine, Columbia University, New York, NY, USA.,Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Division of Global Health Equity, Department of Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - David C Mabey
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Simran Chaudhri
- Department of Population and Family Health & Department of Medicine, Columbia University, New York, NY, USA
| | | | - Stephen D Lawn
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
48
|
Setiawan A, Dawson A. Strengthening the primary care workforce to deliver community case management for child health in rural Indonesia. AUST HEALTH REV 2017; 42:536-541. [PMID: 28965537 DOI: 10.1071/ah17092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022]
Abstract
Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia. Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically. Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs' clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication. Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia. What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care. What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses. What are the implications for practitioners? CCM can be considered to strengthen PHCWs' competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.
Collapse
Affiliation(s)
- Agus Setiawan
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, Kampus Universitas Indonesia Depok, West Java 16424, Indonesia
| | - Angela Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, 15 Broadway Ultimo NSW 2007, Australia. Email
| |
Collapse
|
49
|
Bennett A, Avanceña ALV, Wegbreit J, Cotter C, Roberts K, Gosling R. Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings. Malar J 2017; 16:252. [PMID: 28615026 PMCID: PMC5471855 DOI: 10.1186/s12936-017-1901-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In malaria elimination settings, all malaria cases must be identified, documented and investigated. To facilitate complete and timely reporting of all malaria cases and effective case management and follow-up, engagement with private providers is essential, particularly in settings where the private sector is a major source of healthcare. However, research on the role and performance of the private sector in malaria diagnosis, case management and reporting in malaria elimination settings is limited. Moreover, the most effective strategies for private sector engagement in malaria elimination settings remain unclear. METHODS Twenty-five experts in malaria elimination, disease surveillance and private sector engagement were purposively sampled and interviewed. An extensive review of grey and peer-reviewed literature on private sector testing, treatment, and reporting for malaria was performed. Additional in-depth literature review was conducted for six case studies on eliminating and neighbouring countries in Southeast Asia and Southern Africa. RESULTS The private health sector can be categorized based on their commercial orientation or business model (for-profit versus nonprofit) and their regulation status within a country (formal vs informal). A number of potentially effective strategies exist for engaging the private sector. Conducting a baseline assessment of the private sector is critical to understanding its composition, size, geographical distribution and quality of services provided. Facilitating reporting, referral and training linkages between the public and private sectors and making malaria a notifiable disease are important strategies to improve private sector involvement in malaria surveillance. Financial incentives for uptake of rapid diagnostic tests and artemisinin-based combination therapy should be combined with training and community awareness campaigns for improving uptake. Private sector providers can also be organized and better engaged through social franchising, effective regulation, professional organizations and government outreach. CONCLUSION This review highlights the importance of engaging private sector stakeholders early and often in the development of malaria elimination strategies.
Collapse
Affiliation(s)
- Adam Bennett
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Anton L. V. Avanceña
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Jennifer Wegbreit
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Chris Cotter
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Kathryn Roberts
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Roly Gosling
- Malaria Elimination Initiative, UCSF Global Health Group, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| |
Collapse
|
50
|
Sreeramareddy CT, Low YP, Forsberg BC. Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012. BMC Pediatr 2017; 17:83. [PMID: 28320354 PMCID: PMC5360044 DOI: 10.1186/s12887-017-0836-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. METHODS We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. RESULTS Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. CONCLUSIONS Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
Collapse
Affiliation(s)
| | - Yue-Peng Low
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Birger Carl Forsberg
- Health Systems and Policy Research (HSP), Department of Public Health Sciences, Karolinska Institutet, S-17177 Stockholm, Sweden
| |
Collapse
|