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The use of clinical audit during a successful medical engagement in Afghanistan
145 Commando Royal Marines, RM Condor, Arbroath. adamhewittsmith@gmail.com
Insights
Medical audits in Afghanistan improved pediatric diarrhea care, reducing unnecessary antibiotics by 67% and increasing zinc use by 74%. This demonstrates the audit cycle
Area of Science:
- Global Health
- Medical Education
- Public Health Policy
Background:
- Counter-insurgency operations present unique challenges to healthcare delivery.
- Effective medical engagement requires collaboration with local health systems.
Purpose of the Study:
- To detail a successful medical engagement during counter-insurgency operations in Afghanistan.
- To illustrate the utility of the audit cycle for enhancing local healthcare.
Main Methods:
- An audit of pediatric diarrhea management was conducted at a Ministry of Public Health (MoPH) Basic Health Centre in Nad-e-Ali, Afghanistan.
- Healthcare staff received Integrated Management of Childhood Illnesses (IMCI) training.
- The audit was repeated after further medical engagement and training reinforcement.
Main Results:
- Initially, 90% of children with acute diarrhea received unnecessary antibiotics, and none received recommended zinc supplementation.
- Post-intervention, antibiotic prescriptions decreased by 67%, and zinc supplementation increased by 74%.
Conclusions:
- Medical engagement in operational environments can yield sustainable healthcare improvements when integrated with host nation facilities.
- The audit cycle provides objective data to motivate local healthcare providers towards improved patient care standards.
Objectives:
To describe a successful medical engagement during counter-insurgency operations in Afghanistan, and to demonstrate that a full audit cycle can be used in this environment to support improvements to local healthcare delivery.
Methods:
In the district of Nad-e-Ali, Helmand Province, Afghanistan, the management of children under five years of age (under-5s) who presented with diarrhoea to a Ministry of Public Health (MoPH) Basic Health Centre was audited. Staff then attended a training course on the Integrated Management of Childhood Illnesses (IMCI) in Kandahar. After further medical engagement to reinforce this training, the audit was repeated.
Results:
A lack of knowledge of the Afghan government's MoPH guidelines during the initial audit resulted in 90% of under-5s with acute diarrhoea being given unnecessary antibiotics and none receiving zinc as recommended. Following the training course and on-going engagement, there was a 67% reduction in the number of under-5s prescribed antibiotics and a 74% increase in the number who received zinc.
Conclusions:
Opportunities for successful medical engagement during operations are limited but this example demonstrates that in conjunction with host nation facilities, sustainable improvements in healthcare are possible. Secondly, it shows that use of the audit cycle can provide objective evidence that may help encourage local staff to improve their standards of patient care.
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