Koulidiati Jean-Louis, Nesbitt Robin C, Ouedraogo Nobila, Hien Hervé, Robyn Paul Jacob, Compaoré Philippe, Souares Aurélia, Brenner Stephan
Institute of Public Health, Heidelberg University, Heidelberg, Germany.
Centre Muraz, Bobo-Dioulasso, Burkina Faso.
BMJ Open. 2018 May 31;8(5):e020423. doi: 10.1136/bmjopen-2017-020423.
To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso.
We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities' catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services.
Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively.
Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage.
评估布基纳法索农村卫生设施为5岁以下儿童提供的粗略和有效治疗性卫生服务覆盖率。
我们调查了494个基层卫生设施中的1298名儿童健康服务提供者和1681个临床病例，以及这些设施服务范围内7347户家庭中的12497名5岁以下儿童。根据一组指标，从儿童常见疾病管理、儿童重症疾病管理和一般服务准备情况这三个医疗质量维度对卫生设施进行评分。将服务质量与服务利用情况相联系，我们估算了这些选定治疗服务对5岁以下儿童的粗略和有效覆盖率。
各卫生设施的实际表现质量普遍较低，只有12.7%的被调查设施达到我们对高质量的定义标准，57.1%的设施达到我们对中等医疗质量的定义标准。粗略覆盖率为69.5%，而有效覆盖率显示，报告患病的儿童中分别只有5.3%和44.6%获得了高质量或高质量及中等质量的服务。
我们的研究表明，布基纳法索基层卫生设施提供的5岁以下儿童健康服务质量较低，导致人群覆盖率相对较低。对临床治疗指南的依从性差，再加上缺乏进行5岁以下儿童会诊的设备和合格临床工作人员，似乎是造成粗略覆盖率和有效覆盖率之间差距的原因。
