Quality of outpatient hospital care for children under 5 years in Afghanistan

Allison Lind, Anbrasi Edward, Philippe Bonhoure, Lais Mustafa, Peter Hansen, Gilbert Burnham, David H. Peters

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: To determine the quality of outpatient hospital care for children under 5 years in Afghanistan. Design: Case management observations were conducted on 10-12 children under five selected by systematic random sampling in 31 outpatient hospital clinics across the country, followed by interviews with caretakers and providers. Main Outcome Measures: Quality of care defined as adherence to the clinical standards described in the Integrated Management of Childhood Illness. Results: Overall quality of outpatient care for children was suboptimal based on patient examination and caretaker counseling (median score: 27.5 on a 100 point scale). Children receiving care from female providers had better care than those seen by male providers (OR: 6.6, 95% CI: 2.0-21.9, P = 0.002), and doctors provided better quality of care than other providers (OR: 2.7, 95% CI: 1.1-6.4, P = 0.02). The poor were more likely to receive better care in hospitals managed by non-governmental organizations than those managed by other mechanisms (OR: 15.2, 95% CI: 1.2-200.1, P = 0.04). Conclusions: Efforts to strengthen optimal care provision at peripheral health clinics must be complemented with investments at the referral and tertiary care facilities to ensure care continuity. The findings of improved care by female providers, doctors and NGO's for poor patients, warrant further empirical evidence on care determinants. Optimizing care quality at referral hospitals is one of the prerequisites to ensure service utilization and outcomes for the achievement of the Child health Millennium Development Goals for Afghanistan.

Original languageEnglish (US)
Article numbermzq081
Pages (from-to)108-116
Number of pages9
JournalInternational Journal for Quality in Health Care
Issue number2
StatePublished - Apr 2011


  • Afghanistan
  • Child health
  • Hospitals
  • IMCI
  • Quality of care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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