Primary Care Case Management of Febrile Children: Insights From the ePOCT Routine Care Cohort in Dar es Salaam, Tanzania

Frontiers in Pediatrics

article

Josephine van de Maat¹  Olga De Santis³  Lameck Luwanda⁴  Rainer Tan³  Kristina Keitel⁶ 

[1] Department of Internal Medicine and Radboudumc Center for Infectious Diseases;Department of General Paediatrics;Unisanté – University Center for General Medicine and Public Health;Ifakara Health Institute;Swiss Tropical and Public Health Institute;Department of Pediatric Emergency Medicine, Department of Pediatrics, University Hospital, University of Bern

关键词: infectious diseases;    low-resource setting;    primary care;    quality of care;    decision-support;    pediatrics;    fever;   

DOI  :  10.3389/fped.2021.626386

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Aim: To provide insight in the primary health care (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care. Methods: We used data from the routine care arm of the ePOCT trial, including children aged 2–59 months who presented with an acute febrile illness to two health centers in Dar es Salaam (2014–2016). The presenting complaint, anthropometrics, vital signs, test results, final diagnosis, and treatment were prospectively collected in all children. We used descriptive statistics to analyze the frequencies of diagnoses, adherence to diagnostics, and prescribed treatments. Results: We included 547 children (47% male, median age 14 months). Most diagnoses were viral: upper respiratory tract infection (60%) and/or gastro-enteritis (18%). Vital signs and anthropometric measurements taken by research staff and urinary testing failed to influence treatment decisions. In total, 518/547 (95%) children received antibiotics, while 119/547 (22%) had an indication for antibiotics based on local guidelines. Antibiotic dosing was frequently out of range. Non-recommended treatments were common (29%), most often cough syrup and vitamins. Conclusion: Our study points to challenges in using diagnostic test results, concerns regarding quality of antibiotic prescriptions, and frequent use of non-evidence-based complementary medicines in PHC in Tanzania. Larger studies on diagnostic and treatments processes in PHC in Tanzania are needed to inform effective solutions to support PHC workers in case management of children.

【 授权许可】

CC BY