An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural ghana.


Baiden, F; Owusu-Agyei, S; Bawah, J; Bruce, J; Tivura, M; Delmini, R; Gyaase, S; Amenga-Etego, S; Chandramohan, D; Webster, J; (2011) An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural ghana. PloS one, 6 (12). e28944. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0028944

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Abstract

BACKGROUND The shift to test-based management of malaria represents an important departure from established practice under the Integrated Management of Childhood Illnesses (IMCI). The possibility of false results of tests for malaria and co-morbidity, however, make it important that guidelines in IMCI case assessment are still followed. METHODS AND FINDINGS We conducted a cross-sectional observational study to evaluate current practices in IMCI-based assessment of febrile children in 10 health centres and 5 district hospitals, with follow up of a subset of children to determine day 7-10 post-treatment clinical outcome. Clinical consultation, examination and prescribing practices were recorded using a checklist by trained non-medical observers. The facility case management of 1,983 under-five years old febrile children was observed and 593 followed up at home on days 5-10. The mean number of tasks performed from the 11 tasks expected to be done by the IMCI guidelines was 6 (SD 1.6). More than 6 tasks were performed in only 35% of children and this varied substantially between health facilities (range 3-85%). All 11 tasks were performed in only 1% of children. The most commonly performed tasks were temperature measurement (91%) and weighing (88%). Respiratory rate was checked in only 4% of children presenting with cough or difficulty in breathing. The likelihood of performing "better than average number of tasks" (>6) was higher when the consultation was done by medical assistants than doctors (O.R.?=?3.16, 1.02-9.20). The number of tasks performed during assessment did not, however, influence clinical outcome (O.R.?=?1.02, 0.83-1.24). CONCLUSION Facility-tailored interventions are needed to improve adherence to IMCI guidelines incorporating test-based management of malaria. Studies are needed to re-evaluate the continued validity of tasks defined in IMCI case assessment guidelines.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: ACT Consortium
Centre for Evaluation
Malaria Centre
Centre for Maternal, Reproductive and Child Health (MARCH)
Related URLs:
PubMed ID: 22174932
Web of Science ID: 298367300034
URI: http://researchonline.lshtm.ac.uk/id/eprint/59288

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