A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin

Rowe, Alexander K.; Onikpo, Faustin; Lama, Marcel; Osterholt, Dawn M.; Rowe, Samantha; Deming, Michael S.

doi:10.2105/ajph.2008.134411

Cited by 78 publications

(94 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is evidence that active on-going efforts to support changes in practice may be required beyond the initial implementation period (e.g. [45, 48, 49]. This has important resource implications for health planners looking to embed improvements into routine clinical care.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Docherty

Shaw

Goulding

et al. 2017

Int J Ment Health Syst

View full text Add to dashboard Cite

BackgroundThere is a significant treatment gap in provision of effective treatment for people with mental disorders globally. In some Low and Middle Income Countries (LMICs) this gap is 90% or more in terms of untreated cases. Clinical practice guidelines (CPGs) are one tool to improve health care provision. The aim of this review is to examine studies of the effectiveness of evidence-based CPG implementation across physical and mental health care, to inform mental healthcare provision in low and middle income countries (LMICs), and to identify transferable lessons from other non-communicable diseases to mental health.MethodsA systematic literature review employing narrative synthesis and utilising the tools developed by the Cochrane Effective Practice and Organisation of Care (EPOC) group was conducted. Experimental studies of CPG implementation relating to non-communicable diseases, including mental disorders, in LMICs were retrieved and synthesised.ResultsFew (six) studies were identified. Four cluster randomised controlled trials (RCTs) related to the introduction of CPGs for non-communicable diseases in physical health; one cluster-RCT included CPGs for both a non-communicable disease in physical health and mental health, and one uncontrolled before and after study described the introduction of a CPG for mental health. All of the included studies adopted multi-faceted CPG implementation strategies and used education as part of this strategy. Components of the multi-faceted strategies were sometimes poorly described. Results of the studies included generally show statistically significant improvement on some, but not all, outcomes.ConclusionEvidence for the effectiveness of interventions to improve uptake of, and compliance with, evidence-based CPGs in LMICs for mental disorders and for other non-communicable diseases is at present limited. The sparse literature does, however, suggest that multifaceted CPG implementation strategies that involve an educational component may be an effective way of improving guideline adherence and therefore of improving clinical outcomes. Further work is needed to examine cost-effectiveness of CPG implementation strategies in LMICs and to draw conclusions on the transferability of implementation experience in physical health care to mental health practice settings. Strategies to ensure that CPGs are developed with clear guidance for implementation, and with explicit, methods to evaluate them should be a priority for mental health researchers and for international agencies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-016-0115-1) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Docherty

Shaw

Goulding

et al. 2017

Int J Ment Health Syst

View full text Add to dashboard Cite

show abstract

“…indicators of case management quality compared with reference guidelines) rather than health outcomes 30 , 31 . We did not assess mortality or morbidity because in-hospital, postneonatal mortality in countries in the WHO European Region is too low to be used for evaluating interventions and because, to be reliable, data on morbidity (such as the proportion of children with complications from common diseases) should be collected at hospital, primary care and community levels.…”

Section: Discussionmentioning

confidence: 99%

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Lazzerini

Shukurova

Davletbaeva³

et al. 2016

Bull. World Health Organ.

View full text Add to dashboard Cite

ObjectiveTo determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.MethodsIn a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.FindingsWe prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.ConclusionPeriodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.

show abstract

“…4,[6][7][8] Regarding the significance of IMCI workshops, the need to use creative and new educational methods for a better understanding and performance is very important. Problem-based learning (PBL) is an educational method, e.g., commonly used in medical schools in different countries and has the advantage of better knowledge retention.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Methods: Problem-based Learning vs Lecture in Integrated Management of Childhood Illness Workshops

Assadi¹,

Khoshnevisasl²,

Sadeghzadeh³

et al. 2016

Journal of Postgraduate Medicine, Education and Research

View full text Add to dashboard Cite

Objectives: The aim of this study was to compare problembased learning (PBL) with lecture presentation in education of clinical medical students in Integrated Management of Childhood Illness (IMCI) workshops. Materials and methods:This crossover interventional study was conducted on clinical medical students in pediatric disease department of Zanjan University of Medical Sciences. Fortyfour students were randomly divided into two groups and two subjects in IMCI courses were chosen. One of the topics was presented as lecture for the first group of students and as PBL for the second group. The second topic was presented as PBL for the first group and as lecture for the second group of students. Results:The students' scores in intervention groups for both topics of "loss of consciousness" and "management of diarrheal diseases" were significantly higher than controls. Each student got significantly higher score in subject presented as PBL. Students preferred PBL compared to lecture for increasing their motivation, a higher quality of education, knowledge retention, and class attractiveness.Discussion: Besides the attractiveness of PBL, it seems that this method is more successful than lecture in increasing student's knowledge. We propose to use this method in workshops and medical education in clinic and hospital wards.

show abstract

A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin

Abstract: IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.

Cited by 78 publications

References 16 publications

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

Comparison of Two Methods: Problem-based Learning vs Lecture in Integrated Management of Childhood Illness Workshops

Contact Info

Product

Resources

About