Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda

Malaria Journal

Research

Pascal Magnussen¹  Esther Buregyeya²  Sham Lal³  Sîan E. Clarke³  Kristian S. Hansen⁴  Elizeus Rutebemberwa⁵  Phillip LaRussa⁶  Anthony K. Mbonye⁷ 

[1] Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark;Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda;Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK;Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda;Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, USA;Ministry of Health, Box 7272, Kampala & School of Public Health-Makerere University, Kampala, Uganda;

关键词: Malaria;    Pneumonia;    Diarrhoea;    Comparison;    Private sector;    Public health facilities;    Management of febrile children;    Under-five children;    Uganda;   

DOI  :  10.1186/s12936-017-1842-8

 received in 2017-02-28, accepted in 2017-04-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPublic health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care.MethodsA survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire.ResultsA total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal.ConclusionDeficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.

【 授权许可】

CC BY   
© The Author(s) 2017