An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa.
An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa.
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DOI：
10.1371/journal.pone.0005937
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发表时间：
2009-06-17
期刊：
影响因子：
3.7
通讯作者：
Qazi S
中科院分区：
文献类型：
--
作者：
Horwood C;Vermaak K;Rollins N;Haskins L;Nkosi P;Qazi S
儿童疾病综合管理是一项战略，通过在初级保健一级改进对常见病和重病的病例管理，降低5岁以下儿童的死亡率和发病率，南非于1997年通过了这项战略。我们报告了对南非两个省儿童疾病综合管理实施情况的评价。在74个卫生设施中随机挑选了77名经过儿童疾病综合管理培训的卫生工作者进行观察; 2006年5月至2007年1月期间观察了1 357次咨询。每名卫生工作者都被观察到与连续到该设施就诊的患病儿童进行多达20次的会诊，然后由一名儿童疾病综合管理专家对每名儿童进行重新评估，以确定正确的结果。被观察的卫生工作者接受了平均32.2个月的儿童疾病综合管理培训，平均接受了17.7次咨询; 50/77（65%）的保健工作者在培训后接受了随访。在大多数情况下，卫生工作者使用儿童疾病综合管理来评估症状，但没有全面实施儿童疾病综合管理。在观察期间，除一名保健工作者外，所有人都提到了儿童疾病综合管理准则。9名（12%）观察的卫生工作者检查了每个儿童的一般危险体征，14名（18%）评估了每个儿童的所有主要症状。51/109（46.8%）例严重分类的儿童被正确识别。567/1357（47.5%）儿童的营养状况未分类。卫生工作者正在实施儿童疾病综合管理，但评估往往不完整，需要紧急转诊的儿童被遗漏。如果要扩大关键的儿童生存干预措施的覆盖面，就需要采取干预措施，确保有能力查明具体的迹象，并鼓励儿童疾病综合管理从业人员对儿童进行全面评估。监督在保持卫生工作者技能方面的作用需要进一步调查。
Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under 5 years by improving case management of common and serious illnesses at primary health care level, and was adopted in South Africa in 1997. We report an evaluation of IMCI implementation in two provinces of South Africa. Seventy-seven IMCI trained health workers were randomly selected and observed in 74 health facilities; 1357 consultations were observed between May 2006 and January 2007. Each health worker was observed for up to 20 consultations with sick children presenting consecutively to the facility, each child was then reassessed by an IMCI expert to determine the correct findings. Observed health workers had been trained in IMCI for an average of 32.2 months, and were observed for a mean of 17.7 consultations; 50/77(65%) HW's had received a follow up visit after training. In most cases health workers used IMCI to assess presenting symptoms but did not implement IMCI comprehensively. All but one health worker referred to IMCI guidelines during the period of observation. 9(12%) observed health workers checked general danger signs in every child, and 14(18%) assessed all the main symptoms in every child. 51/109(46.8%) children with severe classifications were correctly identified. Nutritional status was not classified in 567/1357(47.5%) children. Health workers are implementing IMCI, but assessments were frequently incomplete, and children requiring urgent referral were missed. If coverage of key child survival interventions is to be improved, interventions are required to ensure competency in identifying specific signs and to encourage comprehensive assessments of children by IMCI practitioners. The role of supervision in maintaining health worker skills needs further investigation.
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影响因子：
168.9
作者：
Black, RE;Morris, SS;Bryce, J
通讯作者：
Bryce, J
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3.2
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3.2
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168.9
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Black, RE
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168.9
作者：
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