TY - JOUR
T1 - Determining the quality of IMCI pneumonia care in Malawian children
AU - Bjornstad, Erica
AU - Preidis, Geoffrey A.
AU - Lufesi, Norman
AU - Olson, Dan
AU - Kamthunzi, Portia
AU - Hosseinipour, Mina C.
AU - McCollum, Eric D.
PY - 2014/2
Y1 - 2014/2
N2 - Background: Although pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization's Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs). Aim: To assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions. Methods: At an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines. Results: Fewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia. Conclusions: IMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care.
AB - Background: Although pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization's Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs). Aim: To assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions. Methods: At an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines. Results: Fewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia. Conclusions: IMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care.
KW - Developing countries
KW - Guidelines
KW - Paediatrics
KW - Pneumonia
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U2 - 10.1179/2046905513Y.0000000070
DO - 10.1179/2046905513Y.0000000070
M3 - Article
C2 - 24091151
AN - SCOPUS:84893622835
SN - 2046-9047
VL - 34
SP - 29
EP - 36
JO - Paediatrics and International Child Health
JF - Paediatrics and International Child Health
IS - 1
ER -