Lind A, Edward A, Bonhoure P, Mustafa L, Hansen P, Burnham G, Peters DH. Quality of outpatient hospital care for children under 5 years in Afghanistan.
Int J Qual Health Care 2011;
23:108-16. [PMID:
21242157 PMCID:
PMC3115619 DOI:
10.1093/intqhc/mzq081]
[Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE
To determine the quality of outpatient hospital care for children under 5 years in Afghanistan.
DESIGN
Case management observations were conducted on 10-12 children under five selected by systematic random sampling in 31 outpatient hospital clinics across the country, followed by interviews with caretakers and providers.
MAIN OUTCOME MEASURES
Quality of care defined as adherence to the clinical standards described in the Integrated Management of Childhood Illness.
RESULTS
Overall quality of outpatient care for children was suboptimal based on patient examination and caretaker counseling (median score: 27.5 on a 100 point scale). Children receiving care from female providers had better care than those seen by male providers (OR: 6.6, 95% CI: 2.0-21.9, P = 0.002), and doctors provided better quality of care than other providers (OR: 2.7, 95% CI: 1.1-6.4, P = 0.02). The poor were more likely to receive better care in hospitals managed by non-governmental organizations than those managed by other mechanisms (OR: 15.2, 95% CI: 1.2-200.1, P = 0.04).
CONCLUSIONS
Efforts to strengthen optimal care provision at peripheral health clinics must be complemented with investments at the referral and tertiary care facilities to ensure care continuity. The findings of improved care by female providers, doctors and NGO's for poor patients, warrant further empirical evidence on care determinants. Optimizing care quality at referral hospitals is one of the prerequisites to ensure service utilization and outcomes for the achievement of the Child health Millennium Development Goals for Afghanistan.
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