Delivery of paediatric care at the first-referral level in Kenya

English, Mike; Esamai, Fabian; Wasunna, Aggrey; Were, Fred; Ogutu, Bernhards; Wamae, Annah; Snow, Robert W.; Peshu, Norbert

doi:10.1016/s0140-6736(04)17318-2

Cited by 98 publications

(86 citation statements)

References 12 publications

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“…The desire for a career path to move up clinical cadres has also been reported in Kenyan hospitals (English, Esamai, Wasunna et al, 2004). In line with our findings, a study of the effect of decentralisation on healthworkers in Uganda identified respect for professional abilities and the need for a certain level of income to maintain the living standard of the middle class as major concerns to healthworkers, with income level affecting professional identity and vice versa (Kyaddondo & Whyte, 2003).…”

Section: Discussionsupporting

confidence: 89%

“…This highlights the importance of work motivation of existing healthworkers, defined as "an individual"s degree of willingness to exert and maintain an effort towards organizational goals" (Franco, Bennett, & Kanfer, 2002). One particular concern across Africa, including Tanzania, is the poor quality of care at district hospitals (English, Esamai, Wasunna, Were, Ogutu, Wamae et al, 2004;Reyburn, Mwakasungula, Chonya, Mtei, Bygbjerg, Poulsen et al, 2008), where seriously ill patients are referred to and where investment in facilities has been greatest. Low performance and high attrition of healthworkers have in part been attributed to low motivation, an aspect of the human resource crisis which now needs to be better understood if improvements in the performance of public health services is to be achieved (Hongoro & McPake, 2004;World Health Organisation & The World Bank, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians

Chandler

Chonya

Mtei

et al. 2009

Social Science & Medicine

128

158

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians

Chandler

Chonya

Mtei

et al. 2009

Social Science & Medicine

128

158

View full text Add to dashboard Cite

show abstract

“…Even of the true pneumonias some will be viral, including the vaccine-preventable RSV pneumonias, where antibiotics will make little positive impact on outcome [23,24]. In addition, studies of the quality of care suggest that IMCI procedures to diagnose pneumonia, in particular examining the chest and recording respiratory rate, are not well undertaken outside research settings [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Mtove

Hendriksen

Amos

et al. 2011

Malar J

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BackgroundWHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT). However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa.MethodsChildren 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days.ResultsOver the course of one year, 965 children were enrolled; 158 (16.4%) were RDT-positive and treated with artemether-lumefantrine and 807 (83.4%) were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6%) children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2%) children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9%) children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7) and specificity of 96.3% (95%CI 96.3-98.4).ConclusionsUse of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive bacterial disease is uncommon in children with non-severe illness and most cases occurred in infants with a current fever.

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“…Hence, the overhead costs of these factors has led to the services being too expensive for most patients (26)(27). For example, in a study from Kenya, nearly 15% of children with clinical histories indicative of malaria and anaemia could not have their haematocrit tested, and 25% of basic essential tools to facilitate diagnosis and treatment were lacking in 8 out of 14 surveyed hospitals (28). In this context, a reliable and low cost tool like the point-of-care device in this study would have improved the diagnosis of anaemia, prevented misdiagnosis or unwarranted interventions and reduced complications among the subjects.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Testing for Anaemia in Children Using Portable Haematocrit Meter: A Pilot Study from Southwest Nigeria and Implications for Developing Countries

Olatunya

Ogundare

Olaleye

et al. 2016

Ethiop J Health Sci

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BACKGROUND: Prompt and accurate diagnosis is needed to prevent the untoward effects of anaemia on children. Although haematology analyzers are the gold standard for accurate measurement of haemoglobin or haematocrit for anaemia diagnosis, they are often out of the reach of most health facilities in resource-poor settings thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyzer in determining the haematocrit levels in children and to determine its usefulness in diagnosing anaemia in resource-poor settings. METHODS: EDTA blood samples collected from participants were processed to estimate their haematocrits using the two devices (Mindray BC-3600 haematology analyzer and Portable Mission Hb/Haemotocrit testing system). A pairwise t-test was used to compare the haematocrit (PCV) results from the automated haematology analyzer and the portable haematocrit meter. The agreement between the two sets of measurements was assessed using the Bland and Altman method where the mean, standard deviation and limit of agreement of paired results were calculated. RESULTS: The intraclass and concordance correlation coefficients were 0.966 and 0.936. Sensitivity and specificity were 97.85% and 94.51% respectively while the positive predictive and negative predictive values were 94.79% and 97.73%. The Bland and Altman`s limit of agreement was -5.5 ̶ 5.1 with the mean difference being -0.20 and a non-ignificant variability between the two measurements (p = 0.506). CONCLUSION: Haematocrit determined by the portable testing system is comparable to that determined by the haematology analyzer. We therefore recommend its use as a point-of-care device for determining haematocrit in resource-poor settings where haematology analyzers are not available.

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Delivery of paediatric care at the first-referral level in Kenya

Cited by 98 publications

References 12 publications

Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians

Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Point-of-Care Testing for Anaemia in Children Using Portable Haematocrit Meter: A Pilot Study from Southwest Nigeria and Implications for Developing Countries

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