Health worker performance in the management of paediatric fevers following in-service training and exposure to job aids in Kenya

Malaria Journal

Research

Jane Bruce¹  Jayne Webster¹  Caroline Jones²  Robert W Snow³  Dejan Zurovac⁴  Beatrice Wasunna⁵ 

[1] London School of Hygiene and Tropical Medicine (LSHTM), Disease Control and Vector Biology Unit (DCVBU), Keppel Street, WCIE 7HT, London, UK;London School of Hygiene and Tropical Medicine (LSHTM), Disease Control and Vector Biology Unit (DCVBU), Keppel Street, WCIE 7HT, London, UK;KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 230-80108, Kilifi, Kenya;Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100, Kenya Nairobi, GPO, Nairobi, Kenya;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, CCVTM, UK;Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100, Kenya Nairobi, GPO, Nairobi, Kenya;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, CCVTM, UK;Center for International Health and Development, Boston University School of Public Health, 85 East Concord Street, 5th Floor, 02118, Boston, MA, USA;Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast (CGMRC), P.O. Box 43640-00100, Kenya Nairobi, GPO, Nairobi, Kenya;London School of Hygiene and Tropical Medicine (LSHTM), Disease Control and Vector Biology Unit (DCVBU), Keppel Street, WCIE 7HT, London, UK;

关键词: Malaria;    Health Facility;    Health Worker;    Febrile Child;    Government Health Facility;   

DOI  :  10.1186/1475-2875-9-261

 received in 2010-06-25, accepted in 2010-09-18,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundImproving the way artemether-lumefantrine (AL) is provided to patients attending clinics is critical to maximize the benefit of this new medicine. In 2007, a new initiative was launched in one part of Kenya to improve malaria case-management through enhanced in-service training and provision of job aids.MethodsAn evaluation of the intervention using pre- and post-intervention cross sectional health facility surveys was conducted in Bondo district. The surveys included: audit of government health facilities, health worker structured interviews and exit interviews with caretakers of sick children below five years of age. The outcome indicators were the proportions of febrile children who had AL prescribed, AL dispensed, and four different dispensing and counseling tasks performed.ResultsAt baseline 33 government health facilities, 48 health workers and 386 febrile child consultations were evaluated. At follow-up the same health facilities were surveyed and 36 health workers and 390 febrile child consultations evaluated. The findings show: 1) no health facility or health worker was exposed to all components of the intervention; 2) the proportion of health workers who received the enhanced in-service training was 67%; 3) the proportion of febrile children with uncomplicated malaria treated with the first-line anti-malarial drug, artemether-lumefantrine (AL), at health facilities where AL was in stock increased from 76.9% (95%CI: 69.4, 83.1) to 87.6% (95% CI: 82.5, 91.5); 4) there were modest but non-significant improvements in dispensing and counseling practices; and 5) when the analyses were restricted to health workers who received the enhanced in-service training and/or had received new guidelines and job aids, no significant improvements in reported case-management tasks were observed compared to baseline.ConclusionIn-service training and provision of job aids alone may not be adequate to improve the prescribing, dispensing and counseling tasks necessary to change malaria case-management practices and the inclusion of supervision and post-training follow-up should be considered in future clinical practice change initiatives.

【 授权许可】

CC BY   
© Wasunna et al; licensee BioMed Central Ltd. 2010