Predictors of Correct Treatment of Children with Fever Seen at Outpatient Health Facillities in the Central African Republic

Abstract

To identify factors associated with improved performance of health care workers who treat ill children in developing countries, the authors analyzed a sample of consultations of children with malaria (defined as any fever) from a national health facility survey conducted in the Central African Republic from December 1995 to January 1996. Twenty-eight health care workers and 204 children were studied. A univariate analysis revealed the following significant predictors of correct treatment, as defined by the Central African malaria control program: high fever (odds ratio (OR) = 3.25, 95% confidence interval (CI): 1.47, 7.17); correct health care worker diagnosis (OR = 2.59, 95% CI: 1.39, 4.85); and the caregiver's reporting the child's fever to the health care worker (OR = 2.18, 95% CI: 1.32, 3.62). There was an unexpected inverse association between the presence of a fever treatment chart and correct treatment (OR = 0.19, 95% CI: 0.04, 0.91). Correct treatment was marginally associated with a longer consultation time (p value for trend = 0.058). Neither in-service training in the treatment of fever nor supervision was significantly associated with correct treatment. For child health programs to improve, targeted studies are needed to understand which factors, alone or in combination, improve health care worker performance.

Review: Provider Practice and User Behavior Interventions to Improve Prompt and Effective Treatment of Malaria: Do We Know What Works?

“…15 Emphasizing rational drug use and improved provider-client communication during pre-service training, as well as on-site refresher training using opinion leaders or district-level staff and supportive supervision, may be more effective methods for improving the case management of malaria in the formal sector. 11 A series of cross-sectional studies of health worker performance generally found that reported experience of in-service training was not significantly associated with correct treatment of uncomplicated malaria [52][53][54] ; in one of the studies, in-service training was associated with appropriate malaria case management, but only when combined with other interventions such as job aides and frequent supervision. 55 Similar mixed findings were reported by a wider review of (non-malaria-specific) interventions to improve health-worker performance.…”

Management of Pediatric Malaria: Role of Nutritional Interventions

“…The implementation of effective case management with ACT faces a number of challenges, notably complex ordering and financing procedures, the need to train health workers and provide clear guidelines for their use, and their introduction into weak health systems commonly characterized by suboptimal drug management and clinical practices [70,71] . Therefore, despite being promising, new ACT drugs might not reach patients who need them and if they do, the challenge remains to ensure adequate clinical practices.…”

Prise en charge du paludisme pédiatrique: rôle des interventions nutritionnelles

“…Modifications de la mise en oeuvre du traitement par PTA du paludisme pédiatrique non compliqué La mise en oeuvre d'une prise en charge efficace au cas par cas au moyen d'une PTA se heurte à un certain nombre de difficultés (notamment méthodes complexes de commande et de financement, nécessité de la formation des travailleurs de santé et de la fourniture d'instructions claires sur l'emploi de ces produits et introduction de ces derniers dans des systèmes de santé peu efficaces se caractérisant fréquemment par un aspect non optimal des pratiques cliniques et de la gestion des médi-caments [70,71] ). De ce fait, malgré leurs aspects prometteurs, les nouveaux traitements par PTA pourraient ne pas parvenir aux patients qui en ont besoin et, s'ils leur parviennent, la difficulté persistante consiste à assurer des pratiques cliniques adéquates.…”