Assessment of the validity of the guideline for integrated management of adult and adolescent illnesses on HIV patients in Addis Ababa, Ethiopia.
BACKGROUND
. The syndromic approach is a tool by which the case management services can be easily provided in health centers with resource-poor settings at the first contact. The World Health Organization has recommended syndromic management guidelines to be used by first level facility health workers in resource-poor settings to scale-up antiretroviral therapy (ART). However, the validity of the guideline was not assessed


OBJECTIVE
To assess the validity of acute care guideline for Integrated Management of Adult and Adolescent Illness (IMAI) against etiologic and/or clinical approach.


METHODS
The study was conducted in three governmental health centers in Addis Ababa between March and May 2006. Each patient was examined by IMAI trained nurses and then by physicians using the etiologic and/or clinical approach in two different rooms. Specificity, sensitivity, positive predictive value (PPV), and negative predictive values (NPV) were calculated, by taking the decisions made through the etiologic or clinical approach as a gold standard.


RESULTS
A total of 648 clients who were eligible for enrolment during the study period were included in the study. Compared to the diagnosis made by physicians the sensitivity of the guideline for URTI, pneumonia and tuberculosis were found to be 100%, 100%, and 87.5% respectively. The specificity of the guideline for the mentioned disorders was 92.1%, 96.6% and 100% respectively. Among patients with diarrhea the sensitivity and specificity of the guideline for dysentery were 92.5% and 100% respectively. The guideline was found to be 60% sensitive and 100% specific for sever anemia in patients with pallor and 100% sensitivity and 60% specificity for acute anemia.


CONCLUSIONS
The findings of the study suggested that syndromic management of the mentioned diseases at the health center level is possible. However, the performance of the guideline was very poor regarding level of severity in pneumonia, anemia and dehydration. Therefore, the tested guideline needs further modifications with emphasis on their ability in delineating the level of severity.
Woldie
Marta
M
Addis Ababa Health Buero, Ministry of Health.
Enquselassie
Fikre
F
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003152:Community Health Nursing; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000175:diagnosis* / Q000209:etiology; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000451:nursing*; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010346:Patient Care Management; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology