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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
An evaluation of the clinical assessments of Under-Five febrile children presenting to primary health facilities in rural Ghana
PLoS ONE, Volume 6, No. 12, Article e28944, Year 2011
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Description
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. © 2011 Baiden et al.
Authors & Co-Authors
Baiden, Frank E.
Unknown Affiliation
Owusu-Agyei, Seth
Unknown Affiliation
Bawah, Justina
Unknown Affiliation
Bruce, Jane C.
Unknown Affiliation
Tivura, Mathilda
Unknown Affiliation
Delmini, Rupert
Unknown Affiliation
Gyaase, Stephaney
Unknown Affiliation
Amenga-Etego, Stephen D.
Unknown Affiliation
Chandramohan, Daniel
Unknown Affiliation
Webster, Jayne
Unknown Affiliation
Statistics
Citations: 42
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pone.0028944
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Ghana