Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study
| Autor: | Paul Jacob Robyn, Günther Fink, Hannah H. Leslie, Dorothy J. Wei, Gil Shapira, Margaret E Kruk, Saidou Hamadou, Aayush Khadka, Gervais Chamberlin Yama, Nicole A. Perales |
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| Rok vydání: | 2020 |
| Předmět: |
Cross-sectional study
QUALITY OF HEALTH CARE Logistic regression CHILD HEALTH Odds 03 medical and health sciences 0302 clinical medicine CLINICAL PROTOCOL Environmental health Surveys and Questionnaires Health care Medicine Humans 030212 general & internal medicine Cameroon Child Physical Examination business.industry 030503 health policy & services Health Policy Infant Odds ratio Child mortality Central African Republic Cross-Sectional Studies Child Preschool Child Mortality Democratic Republic of the Congo CHILD MORTALITY Catchment area Guideline Adherence Health Facilities 0305 other medical science business Live birth |
| Popis: | This analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2–59 months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016. These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2–59 months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2–59 months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14.1% (adjusted odds ratio (aOR) 95% CI: 0.025–0.244) reduction in the odds of mortality at age 2–59 months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3% (aOR 95% CI: 0.058–0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2–59 months could be possible if compliance were improved. |
| Databáze: | OpenAIRE |
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