Source
International Child Survival and Emerging Infections Program Support Activity, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA. axr9@cdc.gov
Abstract
OBJECTIVES:
To prepare for the implementation of Integrated Management of Childhood Illness (IMCI) in Benin, we studied the management of ill children younger than 5 years at outpatient health facilities.
METHODS:
We observed a representative sample of consultations; after each consultation, we interviewed caregivers and reexamined children. Health workers' performance was evaluated against IMCI guidelines. To identify determinants of performance, statistical modeling was performed and 6 focus groups with health workers were conducted to solicit their opinions.
RESULTS:
Altogether, 584 children were enrolled and 101 health workers were observed; 130 health workers participated in focus group discussions. Many serious deficiencies were found: incomplete assessment of children's signs and symptoms, incorrect diagnosis and treatment of potentially life-threatening illnesses, inappropriate prescription of dangerous sedatives, missed opportunities to vaccinate, and failure to refer severely ill children for hospitalization. Quantitative and qualitative analyses showed various health facility-, health worker-, caregiver-, and child-related factors as possible determinants of health worker performance.
CONCLUSIONS:
Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.