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Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey

BACKGROUND: 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...

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Autores principales: Daka, Dawit Wolde, Wordofa, Muluemebet Abera, Woldie, Mirkuzie, Persson, Lars Åke, Berhanu, Della
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518593/
https://www.ncbi.nlm.nih.gov/pubmed/32976508
http://dx.doi.org/10.1371/journal.pone.0239361
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author Daka, Dawit Wolde
Wordofa, Muluemebet Abera
Woldie, Mirkuzie
Persson, Lars Åke
Berhanu, Della
author_facet Daka, Dawit Wolde
Wordofa, Muluemebet Abera
Woldie, Mirkuzie
Persson, Lars Åke
Berhanu, Della
author_sort Daka, Dawit Wolde
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-75185932020-10-01 Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey Daka, Dawit Wolde Wordofa, Muluemebet Abera Woldie, Mirkuzie Persson, Lars Åke Berhanu, Della PLoS One Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Public Library of Science 2020-09-25 /pmc/articles/PMC7518593/ /pubmed/32976508 http://dx.doi.org/10.1371/journal.pone.0239361 Text en © 2020 Daka et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Daka, Dawit Wolde
Wordofa, Muluemebet Abera
Woldie, Mirkuzie
Persson, Lars Åke
Berhanu, Della
Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title_full Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title_fullStr Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title_full_unstemmed Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title_short Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey
title_sort quality of clinical assessment and management of sick children by health extension workers in four regions of ethiopia: a cross-sectional survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518593/
https://www.ncbi.nlm.nih.gov/pubmed/32976508
http://dx.doi.org/10.1371/journal.pone.0239361
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