Quality of care provided to febrile children presenting in rural private clinics on the Kenyan coast
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Date
2004
Authors
Abuya, T.O.
Molynuex, C.S.
Orago, A. S.
Were, S.
Marsh, V.
Journal Title
Journal ISSN
Volume Title
Publisher
Makerere University Medical School
Abstract
Background: Private sector health facilities are diverse in nature, and offer widely varying quality of care (QOC).
Objectives: The study aimed to describe the QOC provided to febrile children at rural private clinics on the Kenyan coast and
stakeholder perspectives on standards of practice and opportunities for change.
Methods: Data collection methods were structured observations of consultations; interviews with users on exit from clinic and
at home and in depth interviews with private practitioners (PP) and district health managers.
Findings: Private clinics have basic structural features for health care delivery. The majority of the clinics in this study were owned
and run by single-handed trained medical practitioners. Amongst 92 observed consultations, 62% of diagnoses made were
consistent with the history, examinations and tests performed. 74% of childhood fevers were diagnosed as malaria, and 88% of
all prescriptions contained an antimalarial drug. Blood slides for malaria parasites were performed in 55 children (60%). Of those
whose blood slide was positive (n=27), 52% and 48% were treated with a nationally recommended first or second line antimalarial
drug, respectively. Where no blood slide was done (n=37), 73% were prescribed a nationally recommended first line and 27%
received a second line antimalarial drug. Overall, 68 % of antimalarial drugs were prescribed in an appropriate dose and regime.
Both private practitioners and district health managers expressed the view that existing linkages between the public and private
health sectors within the district are haphazard and inadequate.
Conclusions: Although rural PPs are potentially well placed for treatment of febrile cases in remote settings, they exhibit varying
QOC. Practitioners, users and district managers supported the need to develop interventions to improve QOC. The study
identifies the need to consider involvement of the for-profit providers in the implementation of the IMCI guidelines in Kenya.
Description
Research Article
Keywords
Quality of care, Febrile illness, Malaria, Private practitioners, Private clinics
Citation
Afr Health Sci. 2004 Dec;4(3):160-70