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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Baseline assessment of adult and adolescent primary care delivery in Rwanda: An opportunity for quality improvement
BMC Health Services Research, Volume 13, No. 1, Article 518, Year 2013
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Description
Background: As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda. Methods. Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard. Results: Four hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively). Conclusion: Fundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care. © 2013 Vasan et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Vasan, Ashwin
Unknown Affiliation
Manzi, Anatole
Unknown Affiliation
Hedt-Gauthier, Bethany Lynn
Unknown Affiliation
Hirschhorn, Lisa Ruth
Unknown Affiliation
Nkikabahizi, Fulgence
Unknown Affiliation
Hagenimana, Marc
Unknown Affiliation
Ndayisaba, Aphrodis
Unknown Affiliation
Rwabukwisi, Felix Cyamatare
Unknown Affiliation
Nzeyimana, Bonaventure
Unknown Affiliation
Drobac, Peter C.
Unknown Affiliation
Gupta, Neil
Unknown Affiliation
Statistics
Citations: 43
Authors: 11
Affiliations: 8
Identifiers
Doi:
10.1186/1472-6963-13-518
e-ISSN:
14726963
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Study Locations
Rwanda