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Quality of Case Management for Pneumonia and Diarrhea Among Children Seen at Health Facilities in Southern Malawi.
Kobayashi, Miwako; Mwandama, Dyson; Nsona, Humphreys; Namuyinga, Ruth J; Shah, Monica P; Bauleni, Andrew; Vanden Eng, Jodi Vanden; Rowe, Alexander K; Mathanga, Don P; Steinhardt, Laura C.
Afiliación
  • Kobayashi M; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Mwandama D; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Nsona H; Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Namuyinga RJ; Malawi Ministry of Health, Lilongwe, Malawi.
  • Shah MP; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Bauleni A; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Vanden Eng J; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Rowe AK; Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Mathanga DP; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • Steinhardt LC; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Trop Med Hyg ; 96(5): 1107-1116, 2017 05.
Article en En | MEDLINE | ID: mdl-28500813
Pneumonia and diarrhea are leading causes of child deaths in Malawi. Guidelines to manage childhood illnesses in resource-poor settings exist, but studies have reported low health-care worker (HCW) adherence to guidelines. We conducted a health facility survey from January to March 2015 to assess HCW management of pneumonia and diarrhea in children < 5 years of age in southern Malawi, and to determine factors associated with case management quality. Descriptive statistics and multivariable logistic regression models examined patient, HCW, and health facility factors associated with recommended pneumonia and diarrhea management, using Malawi's national guidelines as the gold standard. Of 694 surveyed children 2-59 months of age at 95 health facilities, 132 (19.0%) met survey criteria for pneumonia; HCWs gave recommended antibiotic treatment to 90 (68.2%). Of 723 children < 5 years of age, 222 (30.7%) had uncomplicated diarrhea; HCWs provided recommended treatment to 94 (42.3%). In multivariable analyses, caregivers' spontaneous report of children's symptoms was associated with recommended treatment of both pneumonia (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.2-6.8, P = 0.023) and diarrhea (OR: 24.2, 95% CI: 6.0-97.0, P < 0001). Malaria diagnosis was negatively associated with recommended treatment (OR for pneumonia: 0.5, 95% CI: 0.2-1.0, P = 0.046; OR for diarrhea: 0.3, 95% CI: 0.1-0.6, P = 0.003). To improve quality of care, children should be assessed systematically, even when malaria is suspected. Renewed efforts to invigorate such a systematic approach, including HCW training, regular follow-up supervision, and monitoring HCW performance, are needed in Malawi.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Calidad de la Atención de Salud / Neumonía Bacteriana / Manejo de Caso / Adhesión a Directriz / Diarrea / Malaria Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Adult / Aged / Child, preschool / Female / Humans / Infant / Middle aged País/Región como asunto: Africa Idioma: En Revista: Am J Trop Med Hyg Año: 2017 Tipo del documento: Article País de afiliación: Georgia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Calidad de la Atención de Salud / Neumonía Bacteriana / Manejo de Caso / Adhesión a Directriz / Diarrea / Malaria Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Adult / Aged / Child, preschool / Female / Humans / Infant / Middle aged País/Región como asunto: Africa Idioma: En Revista: Am J Trop Med Hyg Año: 2017 Tipo del documento: Article País de afiliación: Georgia Pais de publicación: Estados Unidos