Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan.

Essa Tawfiq,Sayed Ali Shah Alawi,Kayhan Natiq

doi:10.15171/ijhpm.2019.69

Abstract

Background: Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan. Methods: We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015–2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children. Results: Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index. Conclusion: Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.

Highlights

Afghanistan has achieved significant improvement in reducing under-5, infant and neonatal mortality since 1990
Our study investigated effects of integrated management of childhood illness (IMCI) training courses on health workers performance in terms of history taking, information sharing, counseling/medical advice, and physical examination for under-5 children in primary healthcare facilities in Afghanistan
Findings from our study showed that IMCI training provided to health workers within the last 12 months had positive impact on quality of care for under-5 children

Summary

Introduction

Afghanistan has achieved significant improvement in reducing under-5, infant and neonatal mortality since 1990. Child mortality and morbidity in Afghanistan remains among the highest in the world. According to the Afghanistan Demographic Health Survey 2015, the neonatal mortality rate was 22 deaths per 1000 live births, the infant mortality rate was 45 deaths per 1000 live births, and the under-5 mortality rate was 55 deaths per 1000 live births, meaning that one out of every 18 children died before reaching their fifth birthday.[1] Four-fifths of all deaths in the first 5 years of life occurred during infancy. Data prior to 2010 shows even worse child mortality in the country.[2] The Afghanistan Demographic Health Survey 2015 indicates that child mortality stills remains unacceptably high. To reduce death and illnesses related to these diseases, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) jointly initiated and developed the Integrated Management of Childhood Illnesses (IMCIs) in early 1990s.5,6 IMCI aims to significantly reduce the morbidity and mortality among children under-5 years old, and to contribute to their healthy growth and development through increasing clinical knowledge and skills of health workers, and encouraging

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Discussion

Conclusion