an evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural ghana5岁以下儿童发热的临床评估的评估儿童呈现在加纳农村初级卫生设施.pdfVIP

An Evaluation of the Clinical Assessments of Under-Five Febrile Children Presenting to Primary Health Facilities in Rural Ghana 1 1,2 1 2 1 1 Frank Baiden *, Seth Owusu-Agyei , Justina Bawah , Jane Bruce , Mathilda Tivura , Rupert Delmini , 1 1 2 2 Stephaney Gyaase , Seeba Amenga-Etego , Daniel Chandramohan , Jayne Webster 1 Malaria Group, Kintampo Health Research Centre, Kintampo, Ghana, 2 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom Abstract Background: The shift to test-based management of malaria represents an important departure from established practice under the Integrated Management of Childhood Illnesses (IMCI). The possibility of false results of tests for malaria and co- morbidity, however, make it important that guidelines in IMCI case assessment are still followed. 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 recorded using a checklist by trained non-medical observers. The facility case management of 1,983 under-five years old febrile children was observed and 593 followed up at home on days 5–10. The mean number of tasks performed from the 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 children and this varied substa