Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
Faculty of Public Health, Population and Family Health Department, Jimma University, Jimma, Ethiopia.
PLoS One. 2020 Sep 25;15(9):e0239361. doi: 10.1371/journal.pone.0239361. eCollection 2020.
Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia.
Clinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines.
Most sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers.
The Ethiopian health extension workers' clinical assessment, classification and management of sick children did to a large extent not follow the clinical guidelines. This lack of adherence could lead to misdiagnoses and lack of potentially life-saving treatments.
在埃塞俄比亚初级卫生保健水平上，儿童患病寻求治疗的比例较低。这一问题可能部分归因于社区对所提供医疗质量的负面看法。然而，对于卫生工作者在卫生所提供的临床评估和管理质量知之甚少。本研究旨在检查埃塞俄比亚四个地区的卫生推广工作者为患病五岁以下儿童提供的临床评估、分类和管理质量。
2016 年 12 月至 2017 年 2 月期间，对 620 名患病儿童的卫生推广工作者就诊进行了临床观察。进行了临床路径分析，以分析患病儿童是否根据综合社区病例管理指南进行了适当的评估、分类和管理。
大多数患病儿童的主要症状是咳嗽（58%）、腹泻（36%）和发热（26%）。有呼吸道症状的儿童中，有四分之三（74%，95%CI 69-78）的呼吸频率得到计数，而三分之一（33%，95%CI 27-40）的腹泻儿童得到脱水评估。一半（53%，95%CI 49-57）的患病儿童得到一般危险信号评估，而大多数（89%，95%CI 86-92）的患病儿童手臂周长得到测量以评估营养不良。按照综合社区病例管理指南，一半的患病儿童接受了一些治疗，不到五分之一的患病儿童被转诊。根据综合社区病例管理指南，向 38%（95%CI 35-42）的照顾者提供了全面咨询。
埃塞俄比亚卫生推广工作者对患病儿童的临床评估、分类和管理在很大程度上不符合临床指南。这种不遵守可能导致误诊和缺乏潜在的救生治疗。
