An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana.
<h4>Background</h4>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 t...
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2011
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oai:doaj.org-article:a9c43215f6c946c48828fa38afd321062021-11-18T07:32:26ZAn evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana.1932-620310.1371/journal.pone.0028944https://doaj.org/article/a9c43215f6c946c48828fa38afd321062011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22174932/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods and findings</h4>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).<h4>Conclusion</h4>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.Frank BaidenSeth Owusu-AgyeiJustina BawahJane BruceMathilda TivuraRupert DelminiStephaney GyaaseSeeba Amenga-EtegoDaniel ChandramohanJayne WebsterPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 12, p e28944 (2011) |
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Medicine R Science Q |
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Medicine R Science Q Frank Baiden Seth Owusu-Agyei Justina Bawah Jane Bruce Mathilda Tivura Rupert Delmini Stephaney Gyaase Seeba Amenga-Etego Daniel Chandramohan Jayne Webster An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| description |
<h4>Background</h4>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.<h4>Methods and findings</h4>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).<h4>Conclusion</h4>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. |
| format |
article |
| author |
Frank Baiden Seth Owusu-Agyei Justina Bawah Jane Bruce Mathilda Tivura Rupert Delmini Stephaney Gyaase Seeba Amenga-Etego Daniel Chandramohan Jayne Webster |
| author_facet |
Frank Baiden Seth Owusu-Agyei Justina Bawah Jane Bruce Mathilda Tivura Rupert Delmini Stephaney Gyaase Seeba Amenga-Etego Daniel Chandramohan Jayne Webster |
| author_sort |
Frank Baiden |
| title |
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| title_short |
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| title_full |
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| title_fullStr |
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| title_full_unstemmed |
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. |
| title_sort |
evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural ghana. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2011 |
| url |
https://doaj.org/article/a9c43215f6c946c48828fa38afd32106 |
| work_keys_str_mv |
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