Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republica Tanzania
Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republica Tanzania
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DOI：
10.2471/blt.16.175869
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发表时间：
2017-06-01
影响因子：
11.1
通讯作者：
Leslie, Hannah H.
中科院分区：
文献类型：
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作者：
Kruk, Margaret E.;Chukwuma, Adanna;Leslie, Hannah H.
目的分析在观察到的产前和患病儿童保健在初级保健设施在七个African countries.Methods的质量变化的影响因素，我们汇集了全国代表性的数据，在肯尼亚，马拉维，纳米比亚，卢旺达，塞内加尔，乌干达和坦桑尼亚联合共和国（调查年份范围：2006-2014年）的卫生设施的服务提供评估调查。根据世界卫生组织的协议，我们创建了产前护理（首次就诊）和患病儿童就诊的过程质量指数。我们评估了国家，设施，供应商和病人的因素，可能会解释的变化，在护理质量，使用单独的多层次回归模型的质量为每个service.Findings数据可用于2594和11 402观察产前保健和患病儿童的临床咨询，分别。总体而言，在观察访问中，保健提供者平均执行了62.2%（四分位数间距，IQR：50.0至75.0）的8项建议产前保健行动和54.5%（IQR：33.3至66.7）的9项患病儿童保健行动。产前保健的质量较高，人员配备和设备较好的设施和较低的医生和临床人员比护士。经验丰富的提供者和管理较好的设施提供更高质量的病童护理，医生和护士之间或设备较好和较差的诊所之间没有差异。私人设施优于公共设施。国家差异更有影响力的解释方差的质量比所有其他因素combined.Conclusion的两个基本的初级保健服务的妇女和儿童的质量是薄弱和不同的国家和地区内。分析质量差异的原因可以确定改善护理的战略。
Objective To analyse factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries.Methods We pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organization protocols, we created indices of process quality for antenatal care (first visits) and for sick-child visits. We assessed national, facility, provider and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service.Findings Data were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively. Overall, health-care providers performed a mean of 62.2% (interquartile range, IQR: 50.0 to 75.0) of eight recommended antenatal care actions and 54.5% (IQR: 33.3 to 66.7) of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed and-equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined.Conclusion The quality of two essential primary-care services for women and children was weak and varied across and within the countries. Analysis of reasons for variations in quality could identify strategies for improving care.