scholarly journals Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mtisunge Joshua Gondwe ◽  
Marc Y. R. Henrion ◽  
Thomasena O’Byrne ◽  
Clemens Masesa ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Health Workers ◽  
Health Centre ◽  
Treatment Algorithm ◽  
Secondary Level ◽  
Support Staff ◽  
Health Care Facilities ◽  
Severe Illness ◽  
Primary Health ◽  
Sick Children

Abstract Background Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses. Methods We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions. Results Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility. Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

scholarly journals Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

2020 ◽  
Author(s):  
Mtisunge Joshua Gondwe ◽  
Marc YR Henrion ◽  
Thomasena O’Byrne ◽  
Clemens Masesa ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Health Workers ◽  
Tracking System ◽  
Health Centre ◽  
Secondary Level ◽  
Support Staff ◽  
Health Care Facilities ◽  
Severe Illness ◽  
Primary Health ◽  
Sick Children

Abstract Background: Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children.Objective: Adopting ETAT to improve ability to identify severe illness in children at primary health centre (PHC) level through comparison with secondary level diagnoses.Methods: We implemented ETAT mHealth algorithm at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions.Results: Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E,P,Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%) , while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.56%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility.Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

scholarly journals Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

2020 ◽  
Author(s):  
Mtisunge Joshua Gondwe ◽  
Marc YR Henrion ◽  
Thomasena O’Byrne ◽  
Clemens Masesa ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Health Workers ◽  
Tracking System ◽  
Health Centre ◽  
Secondary Level ◽  
Support Staff ◽  
Health Care Facilities ◽  
Severe Illness ◽  
Primary Health ◽  
Sick Children

Abstract Background: Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. Objective: Adopting ETAT to improve ability to identify severe illness in children at primary health centre (PHC) level through comparison with secondary level diagnoses. Methods: We implemented ETAT mHealth algorithm at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions.Results: Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.56%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility.Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

Childhood Mental Disorders in Primary Health Care: Results of Observations in Four Developing Countries

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 677-683
Author(s):  
R. Giel ◽  
M. V. de Arango ◽  
C. E. Climent ◽  
T. W. Harding ◽  
H. H. A. Ibrahim ◽  
...  
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Health Workers ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Research Procedure ◽  
Primary Health Care Facilities

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

Knowledge of Malaria and Management Practices of Primary Health Care Workers Treating Children with Malaria in Ibadan, Nigeria

2003 ◽  
Vol 22 (1) ◽  
pp. 95-109 ◽  
Author(s):  
O. I. Fawole ◽  
M. O. Onadeko ◽  
C. O. Oyejide
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Management Practices ◽  
Health Workers ◽  
Clinical Skills ◽  
Signs And Symptoms ◽  
Health Care Facilities ◽  
Treatment Practices ◽  
Primary Health ◽  
Physical Examinations

A survey of the knowledge and management practices of 61 health workers in five primary health care facilities in Ibadan 30 health workers observed as they managed children with fever and the parasite status of 92 children diagnosed to have malaria was conducted. Sixty-seven percent of children had the malaria parasite. Knowledge on some basic concepts was fairly adequate as the majority (75.4%) knew the cause of malaria, and 95.1% correctly recognized its key signs and symptoms. Treatment practices were poor as only 55.7% and 63.9% of health workers, respectively, prescribed chloroquine and paracetamol correctly; most gave underdosage. Observation revealed that history taking and physical examinations were rudimentary. Scores out of 100 on correct prescriptions of chloroquine and paracetamol were 60.1 and 76.8, respectively. There is an urgent need for periodic education programs, especially for health workers with many years of experience to help them maintain clinical skills and refresh their knowledge.

Case Management Quality Assessment in Rural Areas of Papua New Guinea

1995 ◽  
Vol 25 (2) ◽  
pp. 69-74 ◽  
Author(s):  
Elvira Beracochea ◽  
Rumona Dickson ◽  
Paul Freeman ◽  
Jane Thomason
Keyword(s):  
Health Services ◽  
Case Management ◽  
Rural Health ◽  
Papua New Guinea ◽  
Health Workers ◽  
Health Centre ◽  
New Guinea ◽  
History Taking ◽  
Primary Health ◽  
Tract Infections

A study was carried out to assess the quality of case management of malaria, malnutrition, diarrhoea and acute respiratory tract infections in children in rural primary health services in Papua New Guinea. In particular, the study focused on the knowledge and skills of different categories of rural health workers (HW) in history taking, examination, diagnosis, treatment and patient education. Quality criteria were defined and health centre (HCW) and aidpost workers' (APWs) knowledge and practices were assessed. Primary health workers' (PHW) knowledge of case management was weak, but in all cases better than their actual practice. History taking and examination practices were rudimentary. HWs tended not to make or record diagnoses. Treatment knowledge was often incorrect, with inappropriate or insufficient drugs prescribed, being worst at aidpost level. These findings raise serious questions about the effectiveness of providing health services through small, isolated health units. Far greater attention must now be directed to focus on the institutionalization of problem-based training, continuous supportive supervision and maintenance of clinical skills and provision of essential drugs, supplies and equipment to ensure that rural health workers (RHW) can provide sound care.

scholarly journals Politicking with Health Care and Its Implications for the Attainment of Universal Health Coverage

2020 ◽  
Author(s):  
Aloysius Odii ◽  
Pamela Ogbozor ◽  
Charles Orjiakor ◽  
Prince Agwu ◽  
Obinna Onwujekwe
Keyword(s):  
Universal Health Coverage ◽  
Local Governments ◽  
Health Workers ◽  
Health Centre ◽  
Healthcare Delivery ◽  
Health Coverage ◽  
Healthcare Staff ◽  
Community Members ◽  
Primary Health ◽  
Universal Health

Abstract Background Primary Health Centres (PHCs) are acknowledged key to the achievement of Universal Health Coverage (UHC) owing to their closeness to the grass-root and the constant patronage by low- and middle-income class citizens. An impediment to the efficiency of PHCs is the nature of politics on-going in its operation beginning from its physical construction, employment of staff, among others. This study provides evidence of politicking marring the efficiency of PHCs as well as possible solutions to the issue. Method The study was carried out in eight purposively selected PHC facilities drawn from three local government areas in Enugu State, southeast Nigeria. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs involved sixteen participants that cut across frontline health workers, heads and supervisors of health units at the local governments, and chairpersons of the health facility committees (HFCCs). In addition, four FGDs were held with male and female service users of the facilities. Findings It was discovered that certain powerful community members influenced the locations of PHCs, even when the general community is disfavoured by such decision. Powerful group of persons equally influence the recruitment and sanctioning of healthcare staff. The consequences include weak patronage of the facilities and poor healthcare delivery. Of the several solutions, obtaining localised support from powerful persons in the community to enforce fairness featured strongly. Conclusions The politics around primary healthcare is a threat to the achievement of UHC, since it discourages patronage and encourages inefficiency of healthcare staff. To overcome this, there is the need to facilitate genuine participation of community members and implementing local actions and policies in the facilitation of PHCs, and also, rapidly addressing the excesses of powerful groups and individuals. Key words: Primary Health Centre; Politicking; Universal Health Coverage; Power; Politics

scholarly journals Factors associated with adherence to the Integrated Management of Childhood Illness (IMCI) guidelines for under-five years’ old care in Burkina Faso primary health care facilities

2019 ◽  
Author(s):  
Sabere Anselme Traoré ◽  
Serge M.A. Somda ◽  
Joël Arthur Kiendrébéogo ◽  
Jean-Louis Kouldiati ◽  
Paul Jacob Robyn ◽  
...  
Keyword(s):  
Health Care ◽  
Health Workers ◽  
Integrated Management ◽  
Health Care Facilities ◽  
Childhood Illness ◽  
Under Five ◽  
Danger Signs ◽  
Primary Health ◽  
Primary Health Care Facilities

AbstractObjectiveTo assess the adherence to Integrated Management of Childhood Illness (IMCI) guidelines in primary health care facilities in Burkina Faso and to determine the factors associated.Materials and MethodsWe used data from a large survey on health facilities, held from October 2013 to April 2014. Primary health facilities were evaluated, health workers interviewed and consultations observed. The standard guideline for an under five year’s old child consultation was the Integrated Management of Childhood Illness (IMCI).Results1,571 consultations were observed, carried out by 522 different practitioners. The danger signs were usually not checked (13.9% only checking for at least three general danger signs). The adherence for cough (74.8%), diarrhoea (64.9%), fever (83.8%) and anaemia (70.3%) was higher. The principal factors found to be associated with poorer adherence to guidelines of consultation were female sex (Rate Ratio (RR) = 0.91; 95% CI 0.86 – 0.95), non-nurse practitioner (RR=0.93; 95% CI 0.88 – 0.97), IMCI training (RR=1.06; 95% CI 1.01 – 1.11), non-satisfaction of the salary (RR=0.95 95% CI 0.91 – 0.99).ConclusionThis study highlights a poor adherence to the IMCI guidelines and by then, revealing a poor quality of under-five care. Indeed, many characteristics of health workers including gender, type of profession, training satisfaction with salary were found to be associated with this adherence. Therefore, more initiatives aiming at improving the quality of care should be developed and implemented for improving the child health care.

scholarly journals Factors associated with the referral of children with severe illnesses at primary care level in Ethiopia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047640
Author(s):  
Habtamu Beyene ◽  
Dejene Hailu Kassa ◽  
Henok Dangiso Tadele ◽  
Lars Persson ◽  
Atkure Defar ◽  
...  
Keyword(s):  
Primary Care ◽  
Severe Disease ◽  
Health Centre ◽  
Severe Illness ◽  
Health Post ◽  
Health Extension Workers ◽  
Cross Sectional ◽  
Factors Associated ◽  
Young Infants ◽  
Sick Children

Context and objectiveEthiopia’s primary care has a weak referral system for sick children. We aimed to identify health post and child factors associated with referrals of sick children 0–59 months of age and evaluate the healthcare providers’ adherence to referral guidelines.DesignA cross-sectional facility-based survey.SettingThis study included data from 165 health posts in 52 districts in four Ethiopian regions collected from December 2018 to February 2019. The data included interviews with health extension workers, assessment of health post preparedness, recording of global positioning system (GPS)-coordinates of the health post and the referral health centre, and reviewing registers of sick children treated during the last 3 months at the health posts. We analysed the association between the sick child’s characteristics, health post preparedness and distance to the health centre with referral of sick children by multivariable logistic regressions.Outcome measureReferral to the nearest health centre of sick young infants aged 0–59 days and sick children 2–59 months.ResultsThe health extension workers referred 39/229 (17%) of the sick young infants and 78/1123 (7%) of the older children to the next level of care. Only 18 (37%) sick young infants and 22 (50%) 2–59 months children that deserved urgent referral according to guidelines were referred. The leading causes of referral were possible serious bacterial infection and pneumonia. Those being classified as a severe disease were referred more frequently. The availability of basic amenities (adjusted OR, AOR=0.38, 95% CI 0.15 to 0.96), amoxicillin (AOR=0.41, 95% CI 0.19 to 0.88) and rapid diagnostic test (AOR=0.18, 95% CI 0.07 to 0.46) were associated with less referral in the older age group.ConclusionFew children with severe illness were referred from health posts to health centres. Improving the health posts’ medicine and diagnostic supplies may enhance adherence to referral guidelines and ultimately reduce child mortality.

scholarly journals Understanding reproductive health challenges during a flood: insights from Belkuchi Upazila, Bangladesh

2019 ◽  
Vol 3 ◽  
pp. 788
Author(s):  
Nibedita S. Ray-Bennett ◽  
Denise M. J. Corsel ◽  
Nimisha Goswami ◽  
Aditi Ghosh
Keyword(s):  
Health Workers ◽  
Health Care Facilities ◽  
Menstrual Regulation ◽  
Primary Health ◽  
Health Infrastructure ◽  
Abortion Complications ◽  
Care Facilities ◽  
Facility Level ◽  
Post Abortion ◽  
Primary Health Care Facilities

Background: Bangladesh is exposed to natural hazards such as floods, cyclones and droughts. As such, its health systems and health infrastructure are exposed to recurrent disasters. Research studying the impacts of natural disasters on reproductive health in particular is lacking. This research contributes to this knowledge gap by studying the challenges related to menstrual regulation and post-abortion care at both the facility and community levels, and the care-seeking patterns of pregnant women during the 2016 flood in Belkuchi, Bangladesh. Methods: Six government-run primary health care facilities were assessed using a structured assessment tool prior to the flood of 2016. In total, 370 structured interviews were conducted with women in three unions of Belkuchi (Belkuchi Sadar, Daulatpur and Bhangabari) 4 months after the 2016 flood. Results: The main challenges at the facility level are a lack of services and a shortage of medicines, equipment and trained health workers. The main challenges at the community level are displacement, high rates of self-diagnosed spontaneous abortion and a lack of treatment for post-abortion complications. A majority of the interviewed women (48%) sought menstrual regulation from the residence of a nurse or family welfare visitor. In total, 73.2% of the women who experienced post-abortion complications sought medical care. Conclusion: To overcome the challenges at the facility level, it is important to construct flood-resistant health infrastructure and train health workers in menstrual regulation and post-abortion care, so that these services can be made available during a flood. At the community level, more research is required to understand the reasons for spontaneous abortions so that these, and the subsequent chronic conditions/complications women experience, may be avoided. Context specific interventions that can overcome local challenges (both at the community and facility levels) are required to promote disaster resilience at primary health care facilities.

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