Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
BMC Health Serv Res. 2023 Feb 16;23(1):165. doi: 10.1186/s12913-023-09131-1.
Despite the expansion of the Integrated Community Case Management services for childhood illness, quality and utilization of services have remained low. To address the problem, the Government of Ethiopia introduced a complex intervention that included community engagement, capacity building of health workers and enhanced district-level ownership of sick child management. We examined whether this complex intervention was associated with improved management of sick children by health extension workers.
The study was conducted in four Ethiopian regions. A baseline survey was conducted in 26 intervention and 26 comparison districts from December 2016 to February 2017, followed by an end-line survey 24 months later. We observed health extension workers' consultations of sick 2-59 months old children. The analysis has evaluated if children with pneumonia, diarrhoea and malnutrition were assessed, classified and treated according to guidelines, and included difference-in-difference analyses.
We observed 1325 consultations of sick children. At baseline, 86% of the sick children with cough in the intervention areas and 85% in comparison areas were assessed according to the guidelines, without any change at end-line associated with the intervention (difference-in-difference = -21%, p = 0.55). Sixty-two percent of children were assessed for dehydration at baseline in intervention and 47% in comparison areas, with no improvement associated with the intervention. Similarly, 87% of sick children in intervention and 91% in comparison areas were assessed for malnutrition, with no change over time associated with the intervention (difference-in-difference = 5%, p = 0.16). Appropriate pneumonia treatment with antibiotics declined and diarrhea treatment increased in both areas. Half of the malnourished children received ready-to-use therapeutic foods without any improvement associated with the intervention.
The intervention was not associated with improved quality of the health extension workers' management of sick children. The lack of association may be linked to low fidelity in the implementation of the intervention. Our findings suggest that training healthcare providers without continued clinical mentoring and support does not improve the quality of care. Community-based programs can be strengthened by ensuring high coverage and continued clinical mentorships, supportive supervision, and supply of medicines and other essential commodities.
ISRCTN12040912, retrospectively registered on 19/12/ 2017.
尽管综合社区病例管理服务在儿童疾病方面得到了扩展，但服务的质量和利用情况仍然很低。为了解决这个问题，埃塞俄比亚政府引入了一项复杂的干预措施，包括社区参与、卫生工作者能力建设和增强区一级对儿童疾病管理的所有权。我们研究了这种复杂的干预措施是否与卫生推广人员对患病儿童的管理的改善有关。
该研究在埃塞俄比亚的四个地区进行。基线调查于 2016 年 12 月至 2017 年 2 月在 26 个干预区和 26 个对照区进行，随后在 24 个月后进行了终点调查。我们观察了卫生推广人员对 2-59 个月大的患病儿童的咨询情况。分析评估了肺炎、腹泻和营养不良儿童是否按照指南进行评估、分类和治疗，并包括了差异分析。
我们观察了 1325 次患病儿童的咨询情况。在基线时，86%的咳嗽患儿在干预区和 85%的对照区根据指南进行了评估，在干预结束时没有变化（差异为-21%，p=0.55）。62%的患儿在干预区和 47%的对照区进行脱水评估，干预没有改善。同样，87%的患病儿童在干预区和 91%的对照区进行营养不良评估，干预没有随时间而变化（差异为 5%，p=0.16）。接受抗生素治疗的肺炎患儿减少，而接受腹泻治疗的患儿增加。一半的营养不良儿童接受了现成的治疗性食品，但干预没有改善。
干预措施与卫生推广人员对患病儿童的管理质量的改善无关。这种缺乏关联可能与干预措施的低保真度有关。我们的研究结果表明，仅培训医疗保健提供者，而没有持续的临床指导和支持，并不会改善护理质量。可以通过确保高覆盖率和持续的临床指导、支持性监督以及提供药品和其他必要商品来加强基于社区的方案。
ISRCTN84101164，于 2017 年 12 月 19 日进行了回顾性注册。
