Trends in the quality of health care for children aged less than 5 years in Afghanistan, 2004–2006

Edward, Anbrasi; Dwivedi, Vikas; Mustafa, Lais; Hansen, Peter M.; Peters, David H.; Burnham, Gilbert

doi:10.2471/blt.08.054858

Cited by 18 publications

(15 citation statements)

References 22 publications

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“…Were the 7-Day course to be adopted in Afghanistan, the importance of ensuring adequate emphasis of the concepts in the fever module must be stressed to avoid underclassification of malaria. Several advantages of using the shortened course include: a) the ability to train more health workers in settings like Afghanistan where turnover of trained health workers is common; b) reduced cost of training per health worker in countries that rely on external funding for healthcare, (a 36% cost savings was projected per course given in Afghanistan, findings substantiated in Zambia, Uganda and Kosovo) (13); and c) the possibility to re-allocate resources to provide supervisory visits, an activity that this evaluation and others suggest can maintain the long-term benefits of shorter IMCI training courses (9,10,20). In addition, shortening the course responds directly to requests of NGO health workers who implemented IMCI in rural and remote settings where health workers have expressed difficulties in taking courses that last 11 days.…”

Section: Direct Observation Integrated Management Of Childhood Illnesmentioning

confidence: 99%

“…The primary problems identified by the working group were similar to issues identified in other countries: insufficient numbers of health workers were trained in IMCI and there was high attrition amongst those trained (8,18). Previous assessments of the quality of care provided in the Afghan primary health system have highlighted several additional influences on quality of IMCI implementation: availability of doctors, having ever received standard IMCI training, short appointment times for patients due to large patient volumes, and factors such as provider job satisfaction, availability of clinical guidelines, frequency of supervision and the presence of community councils (9,10,19,20). In Afghanistan 71% of IMCI trainees were physicians when the more common types of health workers who provided services to sick children were midwives, nurses and community health workers (17).…”

Section: Introductionmentioning

confidence: 99%

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Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance

Mayhew

Ickx

Newbrander

et al. 2015

Int J Health Policy Manag

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Background: In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained -specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training. Methods: This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training. Results: The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker. Conclusion: Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high.

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Section: Direct Observation Integrated Management Of Childhood Illnesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance

Mayhew

Ickx

Newbrander

et al. 2015

Int J Health Policy Manag

View full text Add to dashboard Cite

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“…Table 3 (15). These investments, aimed at improving service delivery, especially for women and children (16), have produced results that may be associated with reduced childhood morbidity, including: a reduction of almost threequarters in the maternal mortality rate (17), which is attributed to better antenatal and postnatal care (18); an increase of 4000% in the number of births attended by a skilled birth attendant (7); and improved family planning services (19). Another relevant development may be the improvements in water supply, sanitation and hygiene.…”

Section: Discussionmentioning

confidence: 99%

Trends in infectious disease incidence among children in Afghanistan at a time of public health services expansion

Anwar

Burnham

2016

East Mediterr Health J

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This study reviewed trends in the incidence of common communicable diseases among children under five years in Afghanistan between 2005 and 2013, a period of expansion of public health services. New visits to outpatient clinics constituted the denominator for calculating proportions. In 2013, almost three-quarters of all new visits of children to public health services were for an infectious disease, with respiratory infections the most common. Because of inconsistent data collection for some infections early in the period, the trend for infectious diseases as a whole cannot be estimated. However, there was a statistically significant downward trend in the proportion of new visits that were diagnosed as one of the 11 leading communicable diseases from 74.5% in 2005 to 62.1% in 2013 (P < 0.001). There was no difference in communicable disease patterns between provinces, but a higher per capita consultation rate was associated with a higher proportion of the leading infections (P = 0.008). Recent improvements in maternal health, hygiene, and preventive services may have had an impact in reducing the burden of infections. ‫الصحية‬

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“…Within this context, the presence of clinical guidelines has been shown to be a major predictor of clinical care and overall hospital performance, with hospitals in Kabul identified as particularly deficient (18,21,22). Multiple international partners have been involved in guideline development and the Ministry of Public Health (MoPH) has made "enhancing evidence-based decision making" one of its 10 strategic objectives and begun creation of a clinical guidelines unit (23,24).…”

Section: Clinical Guidelines In Afghanistanmentioning

confidence: 99%

Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan

Graham¹,

Tokhi²,

Edward³

et al. 2015

Easter Mediterr Health J

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This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines. RÉSUMÉ La présente étude a analysé l'application des lignes directrices cliniques ainsi que la valeur et le rôle qui leur sont attribués par des cliniciens exerçant dans des hôpitaux pédiatriques et des maternités en milieu urbain. L'effet des stratégies de mise en oeuvre actuelles sur les attitudes, les comportements et les connaissances des cliniciens a également été étudié. Au total, 63 cliniciens exerçant dans sept hôpitaux pédiatriques et maternités de Kaboul (Afghanistan) ont participé à des groupes de discussion thématique structurés. Une méthodologie d'analyse de contenu a été utilisée pour identifier et analyser les thèmes clés. Sept ensembles de lignes directrices, protocoles ou normes ont été identifiés (y compris cinq lignes directrices approuvées par l'OMS). Toutefois, la plupart de ceuxci n'atteignent pas de hauts niveaux d'application. Les facteurs associés à l'application des lignes directrices sont les suivants : l'implication du clinicien dans l'élaboration des lignes directrices ; une formation pluridisciplinaire ; des résultats démontrables ; des perceptions cliniques positives de la qualité des lignes directrices, mais aussi leur adéquation par rapport au contexte. Les activités de mise en oeuvre devraient atteindre les trois principaux objectifs suivants : faire mieux connaître les lignes directrices et promouvoir leur accès ; accentuer la motivation des utilisateurs des lignes directrices cliniques ; et faciliter activement le respect des lignes directrices.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫العرشون‬ ‫و‬ ‫احلادي‬ ‫املجلد‬ ‫الثاين‬ ‫العدد‬ 101

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Trends in the quality of health care for children aged less than 5 years in Afghanistan, 2004–2006

Cited by 18 publications

References 22 publications

Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance

Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance

Trends in infectious disease incidence among children in Afghanistan at a time of public health services expansion

Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan

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