Risk and protective factors for two types of error in the treatment of children with fever at outpatient health facilities in Benin.
BACKGROUND
In developing countries, health workers often do not follow clinical practice guidelines. However, few studies have examined why different types of errors occur.


METHODS
We analysed a sample of consultations of children with non-severe malaria (defined as fever without signs of severe illness) from a health facility survey conducted in Ouémé Département, Benin. Treatment was defined as correct (recommended antimalarial), a minor error (non-recommended antimalarial), or a major error (no antimalarial).


RESULTS
In all, 85 health workers and 289 children were studied. In a multivariate logistic regression analysis, the following factors were significantly associated with major errors: treatment by a physician (adjusted odds ratio [aOR] = 13.57, 95% CI: 1.45-126.75), child's age <12 months (aOR = 3.41, 95% CI: 1.15-10.07), and child's temperature (aOR = 0.58 per degrees C, 95% CI: 0.34-0.97). Factors significantly associated with minor errors were: child's temperature (aOR = 1.43 per degrees C, 95% CI: 1.07-1.92), electricity at the health facility (aOR = 3.10, 95% CI: 1.05-9.17), >/=1 supervision visit in the past 6 months (aOR = 0.33, 95% CI: 0.14-0.77), fever treatment wall chart in the consultation room (aOR = 0.29, 95% CI: 0.12-0.73), and number of non-fever chief complaints (aOR = 0.67 per complaint, 95% CI: 0.48-0.93). In-service training in malaria treatment was not significantly associated with either error type.


CONCLUSIONS
Many factors may influence health worker performance, and factors such as pre-service training may influence performance in unexpected ways. Identifying different errors and analysing them separately can help reveal potential causes that may be masked by combining errors into a single category.
Rowe
Alexander K
AK
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. axr@cdc.gov
Onikpo
Faustin
F
Lama
Marcel
M
Deming
Michael S
MS
D000553:Ambulatory Care / Q000592:standards; D000962:Antimalarials / Q000627:therapeutic use*; D001541:Benin; D002648:Child; D002662:Child Health Services / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000188:drug therapy; D019983:Guideline Adherence; D006282:Health Personnel / Q000592:standards; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008508:Medication Errors; D011787:Quality of Health Care; D012307:Risk Factors
D000962:Antimalarials