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1.
Mahende C, Ngasala B, Lusingu J, Butichi A, Lushino P, Lemnge M, Premji Z, 2014. Aetiology of acute febrile episodes in children attending Korogwe district hospital in north-eastern Tanzania. PLoS One 9: e104197.
-
2.
D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809–817.
-
3.
D’Acremont V, Lengeler C, Genton B, 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J 9: 240.
-
4.
Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA, 2013. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Heal 18: 1406–1415.
-
5.
Brent AJ, Ahmed I, Ndiritu M, Lewa P, Ngetsa C, Lowe B, Bauni E, English M, Berkley JA, Scott JAG, 2006. Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study. Lancet 367: 482–488.
-
6.
O’Dempsey TJD, McArdle TF, Laurence BE, Todd JE, Greenwood BM, Lamont AC, 1993. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg 87: 662–665.
-
7.
Eliades MJ, Alombah F, Wun J, Burnett S, Martin T, Kutumbakana S, Dena R, Saye R, Lim P, Hamilton P, 2019. Perspectives on implementation consiederations and costs of malaria case management supportive supervision. Am J Trop Med Hyg 100: 861–867.
-
8.
Namagembe A et al. 2012. Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda. Malaria J 11: 44.
-
9.
WHO, 2012. Training Module on Malaria Control: Case Management. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/malaria/publications/atoz/9789241503976/en/. Accessed January 10, 2019.
-
10.
WHO, 2014. IMCI Chart Booklet. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/maternal_child_adolescent/documents/IMCI_chartbooklet/en/. Accessed January 10, 2019.
-
11.
Burnett S, Wun J, Evance I, Davis K, Smith G, Lussiana C, Tesha G, Quao A, Robertson M, Hamilton P, 2019. Introduction of an electronic tool for improved data quality and data use during malaria case management supportive supervision. Am J Trop Med Hyg 100: 889–898.
-
12.
MalariaCare, PATH, 2017. Universal Diagnosis and Treatment to Improve Matenal and Child Health. MalariaCare Project Year 4 Annual Report, October 2015–September 2016. Seattle, WA: USAID. Available at: https://www.pmi.gov/docs/default-source/default-document-library/implementing-partner-reports/malariacare-year-4-annual-report-universal-diagnosis-and-treatment-to-improve-maternal-and-child-health.pdf. Accessed January 10, 2019.
-
13.
Zurovac D, Rowe AK, 2006. Quality of treatment for febrile illness among children at outpatient facilities in sub-Saharan Africa. Ann Trop Med Parasitol 100: 642.
-
14.
Berendes S, Heywood P, Oliver S, Garner P, 2011. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 8: e1000433.
-
15.
Namuyinga RJ et al. 2017. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J 16: 40.
-
16.
Johansson EW, Selling KE, Nsona H, Mappin B, Gething PW, Petzold M, Peterson SS, Hildenwall H, 2016. Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census. Malar J 15: 1–12.
-
17.
Baiden F, Owusu-Agyei S, Bawah J, Bruce J, Tivura M, Delmini R, Gyaase S, Amenga-Etego S, Chandramohan D, Webster J, 2011. An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. PLoS One 6: 1–8.
-
18.
Imani P, Jakech B, Kirunda I, Mbonye MK, Naikoba S, Weaver MR, 2015. Effect of integrated infectious disease training and on-site support on the management of childhood illnesses in Uganda: a cluster randomized trial. BMC Pediatr 15: 1–14.
-
19.
Arifeen SE et al. 2005. Quality of care for under-fives in first-level health facilities in one district of Bangladesh. Bull World Health Organ 83: 260–267.
-
20.
Kruk ME, Chukwuma A, Mbaruku G & Leslie H 2017. Variation in quality of primary-care services in Kenya, Malawi, Namimbia, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ 95: 408–418.
-
21.
Kruk ME, Gage AD, Mbaruku GM, Leslie HH, 2018. Content of care in 15,000 sickchild consultations in nine lower-income countries. Health Serv Res 53: 2084–2098.
-
22.
Parand A, Dopson S, Renz A, Vincent C, 2014. The role of hospital managers in quality and patient safety: a systematic review. BMJ Open 4: e005055.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 882 | 557 | 29 |
| Full Text Views | 1161 | 9 | 0 |
| PDF Downloads | 290 | 13 | 0 |
Effect of Supportive Supervision on Competency of Febrile Clinical Case Management in Sub-Saharan Africa
Troy Martin
Troy Martin
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
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M. James Eliades
M. James Eliades
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
Malaria, Asia; Population Services International, Yangon, Myanmar;
Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York;
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Malaria, Asia; Population Services International, Yangon, Myanmar;
Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York;
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Jolene Wun
Jolene Wun
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
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Sarah M. Burnett
Sarah M. Burnett
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
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Fozo Alombah
Fozo Alombah
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
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Raphael Ntumy
Raphael Ntumy
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Accra, Ghana;
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McPherson Gondwe
McPherson Gondwe
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Lilongwe, Malawi;
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Beatrice Onyando
Beatrice Onyando
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya;
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Samwel Onditi
Samwel Onditi
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya;
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Boubacar Guindo
Boubacar Guindo
President’s Malaria Initiative (PMI) MalariaCare Project, Population Services International, Bamako, Mali
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Paul Hamilton
Paul Hamilton
President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia;
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Since 2010, the WHO has recommended that clinical decision-making for malaria case management be performed based on the results of a parasitological test result. Between 2015 and 2017, the U.S. President’s Malaria Initiative–funded MalariaCare project supported the implementation of this practice in eight sub-Saharan African countries through 5,382 outreach training and supportive supervision visits to 3,563 health facilities. During these visits, trained government supervisors used a 25-point checklist to observe clinicians’ performance in outpatient departments, and then provided structured mentoring and action planning. At baseline, more than 90% of facilities demonstrated a good understanding of WHO recommendations—when tests should be ordered, using test results to develop an accurate final diagnosis, severity assessment, and providing the correct prescription. However, significant deficits were found in history taking, conducting a physical examination, and communicating with patients and their caregivers. After three visits, worker performance demonstrated steady improvement—in particular, with checking for factors associated with increased morbidity and mortality: one sign of severe malaria (72.9–85.5%), pregnancy (81.1–87.4%), and anemia (77.2–86.4%). A regression analysis predicted an overall improvement in clinical performance of 6.3% (P < 0.001) by the third visit. These findings indicate that in most health facilities, there is good baseline knowledge on the processes of quality clinical management, but further training and on-site mentoring are needed to improve the clinical interaction that focuses on second-order decision-making, such as severity of illness, management of non-malarial fever, and completing the patient–provider communication loop.
Author Notes
Financial support: Financial support was provided by the U.S. President’s Malaria Initiative under the terms of Cooperative Agreement AID-OAA-A-12-00057.
Authors’ addresses: Troy Martin, PATH, Seattle, WA, E-mail: troymmartin@gmail.com. M. James Eliades, Population Services International, Yangon, Myanmar, E-mail: jeliades@psi.org. Jolene Wun, Sarah M. Burnett, Fozo Alombah, and Paul Hamilton, PATH, Washington, DC, E-mails: jwun@path.org, sburnett@path.org, falombah@path.org, and phamilton@path.org. Raphael Ntumy, PATH, Accra, Ghana, E-mail: rntumy@path.org. McPherson Gondwe, PATH, Lilongwe, Malawi, E-mail: mgondwe@path.org. Beatrice Onyando and Samwel Onditi, PATH, Kisumu, Kenya, E-mails: bonyando@path.org and sonditi@path.org. Boubacar Guindo, Population Services International, Bamako, Mali, E-mail: bguindo@psi.org.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Mahende C, Ngasala B, Lusingu J, Butichi A, Lushino P, Lemnge M, Premji Z, 2014. Aetiology of acute febrile episodes in children attending Korogwe district hospital in north-eastern Tanzania. PLoS One 9: e104197.
-
2.
D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809–817.
-
3.
D’Acremont V, Lengeler C, Genton B, 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J 9: 240.
-
4.
Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA, 2013. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Heal 18: 1406–1415.
-
5.
Brent AJ, Ahmed I, Ndiritu M, Lewa P, Ngetsa C, Lowe B, Bauni E, English M, Berkley JA, Scott JAG, 2006. Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study. Lancet 367: 482–488.
-
6.
O’Dempsey TJD, McArdle TF, Laurence BE, Todd JE, Greenwood BM, Lamont AC, 1993. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg 87: 662–665.
-
7.
Eliades MJ, Alombah F, Wun J, Burnett S, Martin T, Kutumbakana S, Dena R, Saye R, Lim P, Hamilton P, 2019. Perspectives on implementation consiederations and costs of malaria case management supportive supervision. Am J Trop Med Hyg 100: 861–867.
-
8.
Namagembe A et al. 2012. Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda. Malaria J 11: 44.
-
9.
WHO, 2012. Training Module on Malaria Control: Case Management. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/malaria/publications/atoz/9789241503976/en/. Accessed January 10, 2019.
-
10.
WHO, 2014. IMCI Chart Booklet. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/maternal_child_adolescent/documents/IMCI_chartbooklet/en/. Accessed January 10, 2019.
-
11.
Burnett S, Wun J, Evance I, Davis K, Smith G, Lussiana C, Tesha G, Quao A, Robertson M, Hamilton P, 2019. Introduction of an electronic tool for improved data quality and data use during malaria case management supportive supervision. Am J Trop Med Hyg 100: 889–898.
-
12.
MalariaCare, PATH, 2017. Universal Diagnosis and Treatment to Improve Matenal and Child Health. MalariaCare Project Year 4 Annual Report, October 2015–September 2016. Seattle, WA: USAID. Available at: https://www.pmi.gov/docs/default-source/default-document-library/implementing-partner-reports/malariacare-year-4-annual-report-universal-diagnosis-and-treatment-to-improve-maternal-and-child-health.pdf. Accessed January 10, 2019.
-
13.
Zurovac D, Rowe AK, 2006. Quality of treatment for febrile illness among children at outpatient facilities in sub-Saharan Africa. Ann Trop Med Parasitol 100: 642.
-
14.
Berendes S, Heywood P, Oliver S, Garner P, 2011. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 8: e1000433.
-
15.
Namuyinga RJ et al. 2017. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J 16: 40.
-
16.
Johansson EW, Selling KE, Nsona H, Mappin B, Gething PW, Petzold M, Peterson SS, Hildenwall H, 2016. Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census. Malar J 15: 1–12.
-
17.
Baiden F, Owusu-Agyei S, Bawah J, Bruce J, Tivura M, Delmini R, Gyaase S, Amenga-Etego S, Chandramohan D, Webster J, 2011. An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. PLoS One 6: 1–8.
-
18.
Imani P, Jakech B, Kirunda I, Mbonye MK, Naikoba S, Weaver MR, 2015. Effect of integrated infectious disease training and on-site support on the management of childhood illnesses in Uganda: a cluster randomized trial. BMC Pediatr 15: 1–14.
-
19.
Arifeen SE et al. 2005. Quality of care for under-fives in first-level health facilities in one district of Bangladesh. Bull World Health Organ 83: 260–267.
-
20.
Kruk ME, Chukwuma A, Mbaruku G & Leslie H 2017. Variation in quality of primary-care services in Kenya, Malawi, Namimbia, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ 95: 408–418.
-
21.
Kruk ME, Gage AD, Mbaruku GM, Leslie HH, 2018. Content of care in 15,000 sickchild consultations in nine lower-income countries. Health Serv Res 53: 2084–2098.
-
22.
Parand A, Dopson S, Renz A, Vincent C, 2014. The role of hospital managers in quality and patient safety: a systematic review. BMJ Open 4: e005055.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 882 | 557 | 29 |
| Full Text Views | 1161 | 9 | 0 |
| PDF Downloads | 290 | 13 | 0 |