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Management of childhood illness at health facilities in Benin: problems and their causes
1International Child Survival and Emerging Infections Program Support Activity, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA. axr9@cdc.gov
Insights
Integrated Management of Childhood Illness (IMCI) implementation in Benin revealed significant gaps in child healthcare. Urgent interventions addressing health system and community factors are needed to improve care for sick children under five.
Area of Science:
- Pediatrics
- Public Health
- Global Health
Background:
- Childhood illnesses pose a significant burden in low-resource settings.
- Effective management of childhood illnesses is crucial for reducing child mortality.
- Benin was preparing to implement the Integrated Management of Childhood Illness (IMCI) strategy.
Purpose of the Study:
- To assess the management of ill children under five years old at outpatient facilities in Benin.
- To identify deficiencies in current healthcare practices prior to IMCI implementation.
- To explore determinants of health worker performance in managing childhood illnesses.
Main Methods:
- Observational study of 584 child consultations.
- Interviews with caregivers and re-examination of children.
- Evaluation of health worker performance against IMCI guidelines, supplemented by focus groups.
Main Results:
- Significant deficiencies identified, including incomplete assessments and incorrect diagnoses/treatments.
- Inappropriate prescription of sedatives and missed vaccination opportunities were noted.
- Failure to refer severely ill children and various performance determinants were documented.
Conclusions:
- Urgent action is required to improve healthcare delivery for children under five.
- Interventions should address both health system-level and community-level factors.
- Findings provide a baseline for evaluating IMCI's impact in Benin.
Objectives:
To prepare for the implementation of Integrated Management of Childhood Illness (IMCI) in Benin, we studied the management of ill children younger than 5 years at outpatient health facilities.
Methods:
We observed a representative sample of consultations; after each consultation, we interviewed caregivers and reexamined children. Health workers' performance was evaluated against IMCI guidelines. To identify determinants of performance, statistical modeling was performed and 6 focus groups with health workers were conducted to solicit their opinions.
Results:
Altogether, 584 children were enrolled and 101 health workers were observed; 130 health workers participated in focus group discussions. Many serious deficiencies were found: incomplete assessment of children's signs and symptoms, incorrect diagnosis and treatment of potentially life-threatening illnesses, inappropriate prescription of dangerous sedatives, missed opportunities to vaccinate, and failure to refer severely ill children for hospitalization. Quantitative and qualitative analyses showed various health facility-, health worker-, caregiver-, and child-related factors as possible determinants of health worker performance.
Conclusions:
Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.
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