Quality of care for under-fives in first-level health facilities in one district of Bangladesh.
Quality of care for under-fives in first-level health facilities in one district of Bangladesh.
复制标题
孟加拉国一个地区的一级卫生机构为五岁以下儿童提供的护理质量。
DOI：
10.1590/s0042-96862005000400009
复制
发表时间：
2005
影响因子：
11.1
通讯作者：
A. Siddique
中科院分区：
文献类型：
--
作者：
S. Arifeen;J. Bryce;E. Gouws;A. Baqui;R. Black;D. Hoque;E. Chowdhury;M. Yunus;N. Begum;T. Akter;A. Siddique
目的
儿童疾病综合管理的成效、成本和影响的多国评价是一项全球评价，旨在确定儿童疾病综合管理对健康结果的影响及其成本效益。孟加拉国、巴西、秘鲁、乌干达和坦桑尼亚联合共和国正在进行履行和监测教育研究。孟加拉国监测和评价研究的这一分析的目的是描述一级政府卫生设施向5岁以下患病儿童提供的护理质量，为政府规划儿童卫生方案提供信息。
方法
通用MCE卫生设施调查工具进行了调整，翻译和预先测试。接受过儿童疾病综合管理培训的医生和这些工具在研究地区的所有19个卫生设施进行了调查。这些数据是通过观察、离职面谈、清单和与设施提供者的面谈收集的。
结果
在这些设施寻求护理的患病儿童中，很少有人得到充分评估或正确治疗，几乎没有一个照顾者得到关于如何在家中继续照顾儿童的建议。超过三分之一的患病儿童的护理被观察到由较低级别的工人谁是显着更有可能比高级别的工人正确分类患病儿童，并提供正确的信息，家庭护理的照顾者。
结论
这些结果表明，迫切需要采取干预措施，以提高在孟加拉国一级设施中为患病儿童提供的护理质量，并表明，将较低级别的工作人员作为儿童疾病综合管理病例管理培训的对象可能是有益的。研究结果表明，儿童疾病综合管理战略提供了一套很有前途的干预措施，以解决孟加拉国的儿童保健服务问题。
OBJECTIVE
The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes.
METHODS
Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers.
FINDINGS
Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver.
CONCLUSION
These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.