Faustin Onikpo

Health worker perceptions of how being observed influences their practices during consultations with ill children

The abscess cavity size was determined by ultrasonography. Abscesses more than 60 mL capacity were observed in 24%, 20% and 12% of patients in groups A, Band C, respectively. Staphylococcus aureus was the only organism isolated in 80% of the specimens and was uniformly sensitive to cefazolin. No growth was observed in the other specimens. Transient bacteraemia was seen in three patients of group C only in whom S. aureus could be isolated in the blood culture. The drain was irrigated if it became blocked but led to secondary infection in 20%, 12%, and 4% patients in groups A, Band C, respectively. Wound infection in the form of frank purulent discharge was observed in 16%, 12% and 24% of patients in groups A, Band C, respectively. Such wounds were laid open and allowed to heal by secondary intention. Excluding cases with infection, healing was achieved in an average of 7.3, 6.9 and 7.4 days in the three groups, respectively. The recurrence rates observed were almost similar 8%, 12% and 10% in group A, Band C, respectively.

Impact of a Malaria-Control Project in Benin That Included the Integrated Management of Childhood Illness Strategy

OBJECTIVES To estimate the impact of the Integrated Management of Childhood Illness (IMCI) strategy on early-childhood mortality, we evaluated a malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets (ITNs). METHODS We conducted a before-and-after intervention study that included a nonrandomized comparison group. We used the preceding birth technique to measure early-childhood mortality (risk of dying before age 30 months), and we used health facility surveys and household surveys to measure process indicators. RESULTS Most process indicators improved in the area covered by the intervention. Notably, because ITNs were also promoted in the comparison area childrens ITN use increased by about 20 percentage points in both areas. Regarding early-childhood mortality, the trend from baseline (1999-2001) to follow-up (2002-2004) for the intervention area (13.0% decrease; P < .001) was 14.1% (P < .001) lower than was the trend for the comparison area (1.3% increase; P = .46). CONCLUSIONS Mortality decreased in the intervention area after IMCI and ITN promotion. ITN use increased similarly in both study areas, so the mortality impact of ITNs in the 2 areas might have canceled each other out. Thus, the mortality reduction could have been primarily attributable to IMCIs effect on health care quality and care-seeking.

Trends in health worker performance after implementing the Integrated Management of Childhood Illness strategy in Benin

Objective  Training health workers to use Integrated Management of Childhood Illness (IMCI) guidelines can improve care for ill children in outpatient settings in developing countries. However, even after IMCI training, important performance gaps exist. One potential reason is that the effect of training can rapidly wane. Our aim was to determine if the performance of IMCI‐trained health workers deteriorated over 3 years.

Care takers' recall of Integrated Management of Childhood Illness counselling messages in Benin

A key goal of the Integrated Management of Childhood Illness (IMCI) strategy is to improve the management of childhood illness at health facilities. IMCI guidelines contain many counselling messages, and as it is not known how well caretakers recall these messages, we studied caretakers’ recall of IMCI messages when given under ideal conditions. At a clinic in Benin, a study clinician performed counselling and confirmed caretakers’ comprehension of all messages. Caretakers were randomly assigned to be interviewed either immediately after the consultation or a day later. Recall was assessed with general and focused open-ended questions. Recall was assessed for 55 caretakers, 29.1% of whom were literate. Caretakers received 3-75 messages (mean = 38.7). The mean percentage of messages recalled was 89.7% immediately after the consultation and 81.9% one day later. These results support IMCIs recommendation that health workers should verify caretakers’ comprehension by asking caretakers to repeat counselling messages during consultations.