Programs, UNICEF Uganda, Kampala, Uganda
Programs, UNICEF Uganda, Gulu, Uganda.
BMJ Open Qual. 2023 Feb;12(1). doi: 10.1136/bmjoq-2022-001941.
At 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has 126 outpatient therapeutic care (OTC) sites for managing children with severe acute malnutrition.
Cure rate (CR) in OTC in Karamoja remains below the international standard of over 75%. The study aimed at increasing the CR in 10 OTC sites in Karamoja, from 74.1% to >75% in 13 months.
The study commenced in July 2018, up to September 2019, in purposively selected health facilities in six districts in Karamoja. Quality improvement (QI) methods per the Ministry of Health QI Framework were applied. QI teams (QITs) tracked the outcome of the tested changes for 13 months. χ tests were used to assess the intrafacility and interdistrict association in CR.
Institute for Health Improvement (IHI) (2003) improvement model was applied in this collaborative. QITs conducted root cause analysis of CR gaps, which guided them in the development of improvement aims, changes and indicators. QITs used plan-do-study-act cycles to test and adopt the feasible changes.
CR increased from 74.1% to 78.6%, with an overall average of 80% within 13 months. Abim district had the highest CR (83.3%) and Kaabong district the lowest (75.2%). Health centre II (84.0%) had the highest CR. Assigning village health teams to follow up caregivers of children in OTC with missed appointments, allocation of village health teams and local leaders to monitor the administration of ready-to-use therapeutic food to children, and screening and treating comorbidities among children in OTC increased CR.
QI methods focusing on collaborative learning increased CR among children in OTC in Karamoja. Sustaining the gains requires district health offices, partners and health facility management's commitment to institutionalise the QI collaborative learning approaches.
在乌干达，卡拉莫贾地区的儿童消瘦率高达 10%，居全国首位。该地区有 126 个门诊治疗中心（OTC），用于治疗严重急性营养不良的儿童。
卡拉莫贾地区 OTC 的治愈率（CR）仍低于 75%的国际标准。本研究旨在将卡拉莫贾地区 10 个 OTC 站点的 CR 从 74.1%提高到 13 个月后的>75%。
本研究于 2018 年 7 月至 2019 年 9 月在卡拉莫贾六个区的选定卫生机构开展。应用卫生部质量改进（QI）框架中的方法。QI 团队（QIT）在 13 个月内跟踪测试变更的结果。χ 检验用于评估 CR 变化的院内和区际关联。
应用研究所健康改进（IHI）（2003 年）改进模型进行合作。QIT 对 CR 差距进行根本原因分析，这为他们制定改进目标、变更和指标提供了指导。QIT 使用计划-执行-研究-行动循环来测试和采用可行的变更。
CR 从 74.1%提高到 78.6%，13 个月内平均为 80%。阿比姆区的 CR 最高（83.3%），卡邦戈区最低（75.2%）。卫生中心 II 的 CR 最高（84.0%）。分配村卫生团队跟进错过 OTC 预约的儿童的照顾者、分配村卫生团队和地方领导人监督儿童服用即食治疗食品、筛查和治疗 OTC 中儿童的合并症，这些措施提高了 CR。
注重协作学习的 QI 方法提高了卡拉莫贾地区 OTC 中儿童的 CR。维持这一成果需要区卫生办公室、合作伙伴和卫生机构管理层承诺将 QI 协作学习方法制度化。
