scholarly journals Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi

2018 ◽  
Vol 3 (2) ◽  
pp. e000506 ◽  
Author(s):  
Omolara T Uwemedimo ◽  
Todd P Lewis ◽  
Elsie A Essien ◽  
Grace J Chan ◽  
Humphreys Nsona ◽  
...  
Keyword(s):  
Child Mortality ◽  
Low Income ◽  
Guideline Adherence ◽  
Integrated Management ◽  
Care Quality ◽  
Health Facilities ◽  
Childhood Illness ◽  
Sub Saharan Africa ◽  
Adjusted Relative Risk ◽  
Pneumonia Diagnosis

BackgroundPneumonia 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.MethodsData 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.Results3136 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.ConclusionsCare 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.

scholarly journals Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053412
Author(s):  
Josephine Birungi ◽  
Sokoine Kivuyo ◽  
Anupam Garrib ◽  
Levicatus Mugenyi ◽  
Gerald Mutungi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Hiv Infection ◽  
Integrated Care ◽  
Plasma Viral Load ◽  
Integrated Management ◽  
Retention In Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Sub Saharan

BackgroundHIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.ObjectivesTo determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators.Design and settingProspective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala.InterventionClinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments.Primary outcome measuresRetention in care, plasma viral load.FindingsBetween 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478.ConclusionIntegrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

scholarly journals Atenção integrada às doenças prevalentes na infância: prática do enfermeiro

2017 ◽  
Vol 11 (12) ◽  
pp. 5382
Author(s):  
Carla Karoline da Silva Simião ◽  
Dase Luyza Barbosa de Sousa ◽  
Ana Safira Trajano da Silva ◽  
Helena Priscila Soares Pereira ◽  
Donátila Cristina Lima Lopes ◽  
...  
Keyword(s):  
Child Health ◽  
Child Mortality ◽  
Growth And Development ◽  
Professional Training ◽  
Integrated Management ◽  
Family Health ◽  
Structural Aspect ◽  
Childhood Illness ◽  
Health Strategy ◽  
Family Health Strategy

RESUMOObjetivo: identificar na literatura nacional dificuldades enfrentadas pelo enfermeiro na prática do manual Atenção Integrada às Doenças Prevalentes na Infância. Método: revisão integrativa, com dados coletados nas bases de dados Lilacs, Medline e Biblioteca Virtual SciELO. 13 artigos atenderam aos critérios de inclusão e os Descritores para nortear a pesquisa foram: Estratégia Saúde da Família; Enfermagem; Saúde da Criança; Crescimento e Desenvolvimento; Mortalidade Infantil; Indicadores de Mortalidade. Resultados: a pesquisa constatou dificuldades encontradas pelos enfermeiros mediante sua prática na Estratégia Saúde da Família na aplicação à Atenção Integrada às Doenças Prevalentes na Infância, seja no aspecto de estrutura da rede de atenção primária, seja por parte da falta de conhecimento no desenvolvimento do protocolo. Conclusão: foi de relevância enfocar a prática do enfermeiro ao manual da Atenção Integrada às Doenças Prevalentes na Infância para favorecer cuidados e desenvolvimento à saúde da criança, indicando que a aplicação desta prática ainda não é exercida por todos os profissionais, tendo em vista fatores que envolvem desde barreiras no setor de trabalho até falta de capacitação profissional. Descritores: Estratégia Saúde da Família; Enfermagem; Saúde da Criança; Crescimento e Desenvolvimento; Mortalidade Infantil; Indicadores de Mortalidade.ABSTRACTObjective: to identify in the national literature difficulties faced by nurses in putting in practice the Integrated Management of Childhood Illness. Method: integrative review. Data were collected from the Lilacs, Medline, SciELO Virtual Library databases; 13 articles met the inclusion criteria; and the Descriptors to guide the research were: Family Health Strategy, Nursing, Child Health, Growth and Development; Child mortality; Mortality Indicators. Results: the research found difficulties encountered by Family Health Strategy nurses in the application of Integrated Management of Childhood Illness, either on the structural aspect of the primary care network or due to the lack of knowledge in protocol development. Conclusion: it was relevant to focus nurses' practice on the Handbook of Integrated Management of Childhood Illness in favor of the care and development of child health, indicating that the application of this practice has not been practiced yet by all professionals in view of factors such as barriers in their work sector and lack of professional training. Descriptors: Family Health Strategy; Nursing; Child Health; Growth and Development; Child Mortality; Morbidity and Mortality Indicators.RESUMENObjetivo: identificar en la literatura nacional dificultades enfrentadas por el enfermero en la práctica del manual Atención Integrada a las Enfermedades Prevalentes en la Infancia. Método: revisión integradora. Datos recogidos en las bases de datos Lilacs y Medline, Biblioteca Virtual SciELO; 13 artículos atendieron a los criterios de inclusión y los Descriptores para guiar a la investigación fueron: Estrategia Salud de la Familia; Enfermería; Salud del Niño; Crecimiento y Desarrollo; Mortalidad Infantil; Indicadores de Mortalidad. Resultados: la investigación constató dificultades encontradas por los enfermeros mediante su práctica en la Estrategia Salud de la Familia en la aplicación a la Atención Integrada a las Enfermedades Prevalentes en la Infancia, sea en el aspecto de estructura de la red de atención primaria, sea por parte de la falta de conocimiento en el desarrollo del protocolo. Conclusión: fue de relevancia enfocar la práctica del enfermero al manual de la Atención Integrada a las Enfermedades Prevalentes en la Infancia para favorecer cuidados y desarrollo a la salud del niño, indicando que la aplicación de esta práctica aún no es ejercida por todos los profesionales, teniendo en cuenta factores que envuelven desde barreras en el sector de trabajo hasta falta de capacitación profesional. Descriptores: Estrategia de Salud Familiar; Enfermería; Salud del Niño; Crecimiento y Desarrollo; Indicadores de Morbimortalidad.

scholarly journals Spatial patterns of child mortality in Nanoro HDSS site, Burkina Faso

2020 ◽  
Author(s):  
Navideh Noori ◽  
Karim Derra ◽  
Innocent Valea ◽  
Assaf P. Oron ◽  
Aminata Welgo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Child Mortality ◽  
Spatial Patterns ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Wet Season ◽  
Inpatient Facility ◽  
Child Deaths ◽  
Sub Saharan ◽  
Geographical Accessibility

AbstractBackgroundHalf of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but spatial patterns of child mortality in the district had not been studied. Similar studies in other districts indicated accessibility to health facilities as a risk factor, usually without distinction between facility types.MethodsUsing Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and accessibility to inpatient and outpatient health facilities, seasonality of death, and age group.ResultsLiving in homes 40-60 minutes and >60 minutes travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13-2.06) and 1.74 (1.27-2.40) greater hazard of under-5 mortality, respectively, than living in homes <20 minutes from an inpatient facility. No such association was found for outpatient facilities. Seasonality of death was significantly associated with under-5 mortality, and the wet season (July-November) was associated with 1.28 (1.07, 1.53) higher under-5 mortality than the dry season (December-June), likely reflecting the malaria season.ConclusionsOur results emphasize the importance of geographical accessibility to health care, and also distinguish between inpatient and outpatient facilities.

scholarly journals Patterns of child mortality in rural area of Burkina Faso: evidence from the Nanoro health and demographic surveillance system (HDSS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Navideh Noori ◽  
Karim Derra ◽  
Innocent Valea ◽  
Assaf P. Oron ◽  
Aminata Welgo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Burkina Faso ◽  
Child Mortality ◽  
Surveillance System ◽  
Demographic Surveillance System ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Seasonal Effect ◽  
Wet Season ◽  
Inpatient Facility

Abstract Background Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but patterns and potential drivers of heterogeneity in child mortality in the district had not been studied. Similar studies in other districts indicated proximity to health facilities as a risk factor, usually without distinction between facility types. Methods Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and proximity to inpatient and outpatient health facilities, seasonality of death, age group, and standard demographic risk factors. Results Living in homes 40–60 min and > 60 min travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13–2.06) and 1.74 (95% CI: 1.27–2.40) greater hazard of under-5 mortality, respectively, than living in homes < 20 min from an inpatient facility. No such association was found for outpatient facilities. The wet season (July–November) was associated with 1.28 (95% CI: 1.07, 1.53) higher under-5 mortality than the dry season (December–June), likely reflecting the malaria season. Conclusions Our results emphasize the importance of geographical proximity to health care, distinguish between inpatient and outpatient facilities, and also show a seasonal effect, probably driven by malaria.

scholarly journals Effect of the Integrated Management of Childhood Illness strategy on health care quality in Morocco

2006 ◽  
Vol 18 (2) ◽  
pp. 134-144 ◽  
Author(s):  
Joseph F. Naimoli ◽  
Alexander K. Rowe ◽  
Aziza Lyaghfouri ◽  
Rijimati Larbi ◽  
Lalla Aicha Lamrani
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Integrated Management ◽  
Care Quality ◽  
Childhood Illness

scholarly journals Solar-powered oxygen delivery for the treatment of children with hypoxemia: protocol for a cluster-randomized stepped-wedge controlled trial in Uganda

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Conradi ◽  
Qaasim Mian ◽  
Sophie Namasopo ◽  
Andrea L. Conroy ◽  
Laura L. Hermann ◽  
...  
Keyword(s):  
Computer Simulation ◽  
Low Income ◽  
Oxygen Delivery ◽  
Oxygen Therapy ◽  
Respiratory Illness ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Stepped Wedge ◽  
Solar Powered ◽  
Cluster Randomized

Abstract Background Child mortality due to pneumonia is a major global health problem and is associated with hypoxemia. Access to safe and continuous oxygen therapy can reduce mortality; however, low-income countries may lack the necessary resources for oxygen delivery. We have previously demonstrated proof-of-concept that solar-powered oxygen (SPO2) delivery can reliably provide medical oxygen remote settings with minimal access to electricity. This study aims to demonstrate the efficacy of SPO2 in children hospitalized with acute hypoxemic respiratory illness across Uganda. Methods Objectives: Demonstrate efficacy of SPO2 in children hospitalized with acute hypoxemic respiratory illness. Study design: Multi-center, stepped-wedge cluster-randomized trial. Setting: Twenty health facilities across Uganda, a low-income, high-burden country for pediatric pneumonia. Site selection: Facilities with pediatric inpatient services lacking consistent O2 supply on pediatric wards. Participants: Children aged < 5 years hospitalized with hypoxemia (saturation < 92%) warranting hospital admission based on clinical judgement. Randomization methods: Random installation order generated a priori with allocation concealment. Study procedure: Patients receive standard of care within pediatric wards with or without SPO2 system installed. Outcome measures: Primary: 48-h mortality. Secondary: safety, efficacy, SPO2 system functionality, operating costs, nursing knowledge, skills, and retention for oxygen administration. Statistical analysis of primary outcome: Linear mixed effects logistic regression model with 48-h mortality (dependent variable) as a function of SPO2 treatment (before versus after installation), while adjusting for confounding effects of calendar time (fixed effect) and site (random effect). Sample size: 2400 patients across 20 health facilities, predicted to provide 80% power to detect a 35% reduction in mortality after introduction of SPO2, based on a computer simulation of > 5000 trials. Discussion Overall, our study aims to demonstrate mortality benefit of SPO2 relative to standard (unreliable) oxygen delivery. The innovative trial design (stepped-wedge, cluster-randomized) is supported by a computer simulation. Capacity building for nursing care and oxygen therapy is a non-scientific objective of the study. If successful, SPO2 could be scaled across a variety of resource-constrained remote or rural settings in sub-Saharan Africa and beyond. Trial registration Clinicaltrials.gov, NCT03851783. Registered on 22 February 2019.

scholarly journals Setting up a nurse-led model of care for management of Hypertension and Diabetes Mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

2020 ◽  
Author(s):  
Marthe Marie Frieden ◽  
Blessing Zamba ◽  
Nisbert Mukumbi ◽  
Patron Titsha Mafaune ◽  
Brian Makumbe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Low Income ◽  
Hiv Prevalence ◽  
Lessons Learned ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Successful Implementation ◽  
Model Of Care ◽  
Integration Of Care ◽  
Care Clinic

Abstract Background: In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socio-economic challenges and a dual disease burden of HIV and NCDs. Methods: Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general out-patient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Results: Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities.Conclusion: Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

scholarly journals Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019079 ◽  
Author(s):  
Cynthia Boschi-Pinto ◽  
Guilhem Labadie ◽  
Thandassery Ramachandran Dilip ◽  
Nicholas Oliphant ◽  
Sarah L Dalglish ◽  
...  
Keyword(s):  
Low Income ◽  
Integrated Management ◽  
Data File ◽  
Childhood Illness ◽  
Cross Sectional ◽  
Middle Income ◽  
Country Level ◽  
Health Related ◽  
Barriers And Opportunities ◽  
Three Components

ObjectiveTo assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries.SettingThe 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs).MethodsWe conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI’s three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11.ParticipantsIn-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef.ResultsEighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18).ConclusionThis survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.

Sign in / Sign up

Export Citation Format

Share Document