Performance of primary health care workers and the knowledge and practice of mothers/caretakers in the management of children with acute respiratory infections in Dar es Salaam.

Abstract

Acute respiratory infections (ARl) are a major cause of morbidity and mortality in children in developing countries. This is reflected in the global burden of diseases in children, which shows that out of the 12 million deaths which occur in children less than 5 years of age in developing countries, 36% are caused by ARl. Studies have also demonstrated that correct case management of ARl by primary health J care workers can sj~ificantly reduce ARl associated morbidity and mortality in children. Therefore, health care workers should be able to assess, classify and treat children with ARI appropriately according to Standard World Health Organisation (WHO) guidelines - on case management of ARI. For effective control of ARl, the families should also be able to recogmse the symptoms and signs of illness and seek early medical care in the course of the disease. Therefore, a cross-sectional study was undertaken in a primary health care setting in Dar es Salaam region, which documented the clinical performance of the health workers and at the same time looked into the knowledge and practice of mothers/caretakers in relation to the case management of ARl. Objectives of the study 1. To determine the level of performance of primary health care workers ill the assessment, classification and treatment of ARl in children basing on WHO standard case management guidelines. 2. To determine the proportion of primary health care workers who correctly counselled mothers /caretakers on home care of children with ARl. vi

3. To determine the knowledge and practice of mothers/caretakers regarding management of ARI in their children. Methodology A cross-sectional study was carried out in 11 primary health facilities in Dar es Salaam region to determine the performance of health care workers on correct case management of ARI. Furthermore, knowledge and practice of mothers/caretakers regarding management of ARI in their children was also determined. During the study period the author observed and documented the performance of 78 primary health care workers while they were assessing, classifying and treating children who were suffering from ARI using a checklist. The author's clinical assessment was used as the standard yardstick to gauge the performance of the health care workers being studied. Exit interviews using a standard questionnaire were conducted on 246 mothers/caretakers who had children suffering from ARI regarding their knowledge and practice on the management of ARI, and also to determine whether they were properly counselled by the health care 'Y.?rkers on home care of a child with ARI, with regard to compliance with the treatment regimen, increasing fluid intake and feeding the child during illness and when to return to clinic. Results During the study period, 129 episodes of case management of ARI being performed by the health care workers were observed and documented. Of these 129 episodes, correct case assessment was' done in 50% and the correct treatment according to the assigned classification was prescribed in only 46.8% of the cases. VII

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- ~ ~~~~~~- ~~- - - --- -~~-~ - The exit interviews showed that only 20.5% of the health care workers counselled the mothers/caretakers correctly on when to bring the child back for review. The mothers/caretakers knowledge on home management of a child with ARI was correct in 41.9%, and the average duration of onset of illness to reporting to health facility was 3.6 days. Self-medication before seeking medical care was found to be a common practice. Conclusion This study shows that the overall performance of the pnrnary health care workers regarding management of ARI was correct in only 50% of the cases, and was sub-optimal in the other 50% of the cases. The mothers/caretakers' knowledge was satisfactory in only 41.9%, and early treatment seeking behaviour was lacking in the majority and self medication before seeking medical care was found to be a common practice. viu