Content of Care in 15,000 Sick Child Consultations in Nine Lower-Income Countries.

Margaret E Kruk,Hannah H Leslie,Anna D Gage,Godfrey M Mbaruku

doi:10.1111/1475-6773.12842

Margaret E Kruk, Hannah H Leslie + Show 2 more

Open Access

https://doi.org/10.1111/1475-6773.12842

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Abstract

ObjectiveDescribe content of clinical care for sick children in low‐resource settings.Data SourcesNationally representative health facility surveys in Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda from 2007 to 2015.Study DesignClinical visits by sick children under 5 years were observed and caregivers interviewed. We describe duration and content of the care in the visit and estimate associations between increased content and caregiver knowledge and satisfaction.Principal FindingsThe median duration of 15,444 observations was 8 minutes; providers performed 8.4 of a maximum 24 clinical actions per visit. Content of care was minimally greater for severely ill children. Each additional clinical action was associated with 2 percent higher caregiver knowledge.ConclusionsConsultations for children in nine lower‐income countries are brief and limited. A greater number of clinical actions was associated with caregiver knowledge and satisfaction.

Highlights

We investigate visit duration and content of care provided during sick child consultations, variation across key stratifiers, and effects on caregiver knowledge and satisfaction
We selected key visit attributes at the facility, provider, and child levels, including private versus public facility, service readiness of the facility as defined by the World Health Organization (WHO; World Health Organization 2013), cadre of health worker, patient volume on day of assessment, whether the child was severely ill, defined as caretaker report of convulsions or both inability to eat or drink and vomiting everything following WHO guidelines for Integrated Management of Childhood Illness (World Health Organization 2014), and diagnosis provider assigned
Of 23,005 sick child consultations observed across the study countries, 15,444 visits in 4,717 facilities met inclusion criteria

Summary

Objective

Describe content of clinical care for sick children in low-resource settings. International donors and governments invest considerable development assistance funding in programs to improve health, including health system strengthening: $37.6 Despite the existence of protocols, quality of clinical care for sick children remains weak in many low-income countries (Gera et al 2016). As the main causes of death in low-income countries shift from readily prevented and treated illness (e.g., diarrhea) to more complex conditions (e.g., neonatal sepsis, pneumonia), poor clinical quality will limit reductions in child mortality (Kruk, Larson, and Twum-Danso 2016). We investigate visit duration and content of care provided during sick child consultations, variation across key stratifiers, and effects on caregiver knowledge and satisfaction

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