Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda

Abstract

In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.

Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda

“…In reality, this would only be possible if the other conditions for provision of quality care are in operation, including health workers with adequate knowledge on management of malaria. A recent article by our research team described inappropriate care for malaria and other common pediatric infections, implying that it requires more than availability of medicines and diagnostics [ 36 ]. The fact that the first line antimalarial medicine for severe malaria, injectable artesunate, was not available in half of the facilities, may imply that children with complicated malaria may not be getting appropriate pre-referral treatment.…”

A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda

“…This qualitative study was nested in a larger quantitative survey of quality of healthcare for common paediatric infections in 110 LLPHFs selected randomly in Mbarara District [21]. The qualitative design was used to enable an in-depth exploration and understanding of healthcare workers' and caretakers' own experiences and perspectives regarding referral practices by LLPHFs providing child health services in Mbarara District.…”