Measuring pediatric quality of care in rural clinics-A multi-country assessment-Cambodia, Guatemala, Zambia and Kenya

Objective: To assess the quality of care provided in rural pediatric facilities in Cambodia, Guatemala, Kenya and Zambia Design: All public health facilities in four districts in each country were included in the assessment. Based on utilization patterns, five children under five were selected randomly from each facility to perform the Integrated Management of Childhood Illness (IMCI) assessments followed by exit interviews with their caretakers. Setting: Seventy rural ambulatory pediatric care facilities. Participants: Three hundred and forty pediatric case management observations and exit interviews with child caretakers. Main outcome measure: IMCI index of observed quality of care for patient assessment and counseling Results: Screening for danger signs, diarrhea and fever showed significant differences between countries (P < 0.001), with facilities in Cambodia and Guatemala performing better. More than 90% of the children were screened for fever in all three countries, but < 75% were screened in Cambodia. The assessment of nutritional status, checking weight against growth chart and palmar pallor for anemia, was suboptimal in all countries. Mean consultation time ranged from 8.2 minutes in Zambia and 12.6 minutes in Guatemala. Child age, consultation time, health provider cadre and presenting symptoms were significantly associated with higher quality of assessment and counseling care as measured by the IMCI index. Conclusions: Achieving the goals of universal health coverage in these contexts must be complimented with accelerated efforts for capacity investments at the primary care level to ensure optimal quality of healthcare and favorable health outcomes for children, who still experience a high disease burden for these common IMCI conditions.