An Evaluation of the Clinical Assessments of Under-Five Febrile Children Presenting to Primary Health Facilities in Rural Ghana 英文参考文献.docVIP
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An Evaluation of the Clinical Assessments of Under-Five Febrile Children Presenting to Primary Health Facilities in Rural Ghana 英文参考文献
AnEvaluationoftheClinicalAssessmentsofUnder-Five
FebrileChildrenPresentingtoPrimaryHealthFacilities
inRuralGhana
FrankBaiden1*,SethOwusu-Agyei1,2,JustinaBawah1,JaneBruce2,MathildaTivura1,RupertDelmini1,
StephaneyGyaase1,SeebaAmenga-Etego1,DanielChandramohan2,JayneWebster2
1MalariaGroup,KintampoHealthResearchCentre,Kintampo,Ghana,2DepartmentofDiseaseControl,LondonSchoolofHygieneandTropicalMedicine,London,United
Kingdom
Abstract
Background:Theshifttotest-basedmanagementofmalariarepresentsanimportantdeparturefromestablishedpractice
undertheIntegratedManagementofChildhoodIllnesses(IMCI).Thepossibilityoffalseresultsoftestsformalariaandco-
morbidity,however,makeitimportantthatguidelinesinIMCIcaseassessmentarestillfollowed.
Methods and Findings: We conducted a cross-sectional observational study to evaluate current practices in IMCI-based
assessment of febrile children in 10 health centres and 5 district hospitals, with follow up of a subset of children to
determine day 7–10 post-treatment clinical outcome. Clinical consultation, examination and prescribing practices were
recordedusingachecklistbytrainednon-medicalobservers.Thefacilitycasemanagementof1,983under-fiveyearsold
febrilechildrenwasobservedand593followedupathomeondays5–10.Themeannumberoftasksperformedfromthe
11 tasks expected to be done by the IMCI guidelines was 6 (SD 1.6). More than 6 tasks were performed in only 35% of
childrenandthisvariedsubstantiallybetweenhealthfacilities(range3–85%).All11taskswereperformedinonly1%of
children.Themostcommonlyperformedtasksweretemperaturemeasurement(91%)andweighing(88%).Respiratoryrate
wascheckedinonly4%ofchildrenpresentingwithcoughordifficultyinbreathing.Thelikelihoodofperforming‘‘better
than average number of tasks’’ (.6) was higher when the consultation was done by medical assistants than doctors
(O.R.=3.16, 1.02–9.20). The number of tasks performed during assessment did not, however, influence clinical outcome
(O.R.=1.02,0.83–1.24).
Conclusion: Facility-tailored interv
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