Management of Malaria, Pneumonia and Diarrhea in Children under Five in Kolofata, Cameroon: An Assessment of Health Worker Performance 公开

Slim, Jessica Jihad (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/c821gk669?locale=zh
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Abstract

Management of Malaria, Pneumonia and Diarrhea in Children under Five in Kolofata, Cameroon: An Assessment of Health Worker Performance
By Jessica Slim


Background: The Far North Region of Cameroon has one of the highest child mortality rates in the country, 186 per 1000 live births. Malaria, pneumonia and diarrhea together with undernutrition are the major causes of death. Proper medical care is critical to reducing child mortality. The Integrated Management of Childhood Illness (IMCI) is an intervention designed for use by health providers in developing countries to reduce mortality among children under age five.

Aim: To measure the quality of care provided to children in the Kolofata Health District of the Far North Region.

Methods: Structured observations of consultations with children were conducted before IMCI intervention in seven health facilities in Kolofata. Clinical performance of health providers was compared to gold-standard IMCI guidelines. Quality of care was determined by assessment of sick children for danger signs, common illnesses, undernutrition, and vaccination status.

Results: Forty-four sick child observations were conducted in seven health facilities. Forty (91%) children presented to the clinic for complaints that are outlined in the IMCI algorithms. Children were assessed by the health providers for the following: zero for 3 or more danger signs, 38 (86%) for cough, 44 (100%) for fever, 42 (96%) for diarrhea, 34 (77%) for anemia and 24 (55%) for vaccination status. Forty-two (96%) children were weighed; zero weights were plotted on a growth chart. The mean integrated assessment score was 6.7 out of 10, indicating room for improvement in health care performance.

Conclusion: The Far North Region is in a silent state of emergency. More than 90% of children observed were undernourished, with 60% severely undernourished. Nonetheless, IMCI implementation has not yet been prioritized to this region. Two IMCI training sessions were provided to local health workers. The importance of using standard WHO growth charts to identify undernourished children was a particular focal point during training.

Table of Contents

Abstract...iv

List of Tables...xi

List of Figures...xi

Introduction...1

Problem Statement...3

Objective...4

Research Question...5

Significance of Study...7

Literature Review...8

Demographic Health Survey, Cameroon 2011...8

Cameroon Snapshot...9

Maternal Health...13

Prenatal Care...14

Birth Place...15

Tetanus Immunization...16

Infant and Child Mortality...18

Acute Respiratory Illnesses, Fever, and Diarrhea...21

Vaccination of Children...27

Nutritional Status...28

Determinants of Under-Five Mortality in Cameroon...30

Integrated Management of Childhood Illness (IMCI)...34

Induction of IMCI in Cameroon...35

IMCI Pilot Project Results...36

IMCI Expansion in Cameroon...41

An Intervention in the Far North...41

Methodology...43

A Baseline Performance Assessment...43

Location...43

Study Site and Participants...45

Selection of Observed Consultations...48

Designing and Preparing for the Assessment...49

Survey Method...49

Data Collection...50

Statistical Analysis...50

Capacity Building...51

Results...52

Chief Complaint...54

Observation Assessment...55

Danger Signs...56

Major Illnesses...57

Nutrition...58

Vaccination Status...60

Facility Support for Vaccinations...61

Index Assessment...62

Diagnosis and Treatment...63

Examination Results...63

Question 1: What should health care workers ask caretakers at every visit?...64

Question 2: What are clinical signs indicating a child is in imminent danger?...65

Questions 3-8: Signs of Respiratory Disease...66

Questions 9-13: Diarrheal Disease and Dehydration...67

Questions 14-16: Fever...69

Question 17: Nutrition...69

Questions 18-25: Vaccination and Integrated Treatment...70

Discussion...71

Review of Study Results with Health Care Workers...72

Danger Signs...72

Common Illnesses...72

Nutrition...73

Vaccination Status...74

Examination Review...75

Limitations...75

Lessons Learned...77

Future Studies...77

References...79

Appendices...84

Appendix A: Selected Indicators for Health by Sociodemographic Characteristics, Cameroon (DHS 2011)...84

Table A1. Maternal Health...84

Table A2. Acute Respiratory Infections and Fever...85

Table A3. Immunization Status...86

Table A4. Nutrition...88

Appendix B: IMCI Guidelines...89

Appendix C: Survey Instrument...93

Appendix D: IMCI Presentation to Kolofata District of Health...95

Appendix E: Examination Review with Health Care Workers...102

Appendix F: 25-Question Examination Given to Health Providers (French)...123

IRB Exemption...127

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