Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study
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 Centra...
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| Format: | Journal Article |
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Oxford University Press
2021
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| Online Access: | http://hdl.handle.net/10986/36729 |
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okr-10986-367292022-01-28T16:21:04Z Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study Perales, Nicole A. Wei, Dorothy Khadka, Aayush Leslie, Hannah H. Hamadou, Saidou Chamberlin Yama, Gervais Robyn, Paul Jacob Shapira, Gil Kruk, Margaret E. Fink, Gunther CHILD HEALTH QUALITY OF HEALTH CARE CLINICAL PROTOCOL CHILD MORTALITY 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. 2021-12-14T19:39:49Z 2021-12-14T19:39:49Z 2020-06 Journal Article Health Policy and Planning http://hdl.handle.net/10986/36729 CC BY-NC-ND 3.0 IGO http://creativecommons.org/licenses/by/-nc-nd3.0/igo World Bank Oxford University Press Publications & Research Publications & Research :: Journal Article Africa Africa Eastern and Southern (AFE) Africa Western and Central (AFW) Cameroon Central African Republic Congo, Democratic Republic of |
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Digital Repository |
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Foreign Institution |
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Digital Repositories |
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World Bank Open Knowledge Repository |
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World Bank |
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CHILD HEALTH QUALITY OF HEALTH CARE CLINICAL PROTOCOL CHILD MORTALITY |
| spellingShingle |
CHILD HEALTH QUALITY OF HEALTH CARE CLINICAL PROTOCOL CHILD MORTALITY Perales, Nicole A. Wei, Dorothy Khadka, Aayush Leslie, Hannah H. Hamadou, Saidou Chamberlin Yama, Gervais Robyn, Paul Jacob Shapira, Gil Kruk, Margaret E. Fink, Gunther Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
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Africa Africa Eastern and Southern (AFE) Africa Western and Central (AFW) Cameroon Central African Republic Congo, Democratic Republic of |
| description |
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. |
| format |
Journal Article |
| author |
Perales, Nicole A. Wei, Dorothy Khadka, Aayush Leslie, Hannah H. Hamadou, Saidou Chamberlin Yama, Gervais Robyn, Paul Jacob Shapira, Gil Kruk, Margaret E. Fink, Gunther |
| author_facet |
Perales, Nicole A. Wei, Dorothy Khadka, Aayush Leslie, Hannah H. Hamadou, Saidou Chamberlin Yama, Gervais Robyn, Paul Jacob Shapira, Gil Kruk, Margaret E. Fink, Gunther |
| author_sort |
Perales, Nicole A. |
| title |
Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
| title_short |
Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
| title_full |
Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
| title_fullStr |
Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
| title_full_unstemmed |
Quality of Clinical Assessment and Child Mortality : A Three-Country Cross-Sectional Study |
| title_sort |
quality of clinical assessment and child mortality : a three-country cross-sectional study |
| publisher |
Oxford University Press |
| publishDate |
2021 |
| url |
http://hdl.handle.net/10986/36729 |
| _version_ |
1764485785539575808 |