Quality assurance of a diarrhoea control programme in northeastern Brazil.
In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern Brazil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed in the facilities were lack of information on target population and coverage, lack of equipment to permit rehydration in the premises, and frequent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling information given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration, but 90% were sent home immediately and not kept in the facilities to practice rehydration under guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The study showed that oral rehydration therapy is well established in the government health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case management and health education.
Department of Social Medicine, Universidade Federal de Pelotas, RS, Brazil.
F C
FC
Barros
B C
BC
Forsberg
C G
CG
Victora
A G
AG
Maranhão
M
M
Stegeman
A
A
Gonzalez-Richmond
R M
RM
Martins
Z A
ZA
Neumann
J
J
McAuliffe
J A
JA
Branco Júnior
D001938:Brazil / Q000453:epidemiology; D017028:Caregivers / Q000193:education; D002648:Child; D003140:Communicable Disease Control / Q000592:standards*; D003625:Data Collection; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005440:Fluid Therapy / Q000592:standards; D006282:Health Personnel / Q000193:education / Q000592:standards; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D008508:Medication Errors; D010808:Physical Examination / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care