Quality of outpatient hospital care for children under 5 years in Afghanistan.
OBJECTIVE
To determine the quality of outpatient hospital care for children under 5 years in Afghanistan.


METHODS
Case management observations were conducted on 10-12 children under five selected by systematic random sampling in 31 outpatient hospital clinics across the country, followed by interviews with caretakers and providers.


METHODS
Quality of care defined as adherence to the clinical standards described in the Integrated Management of Childhood Illness.


RESULTS
Overall quality of outpatient care for children was suboptimal based on patient examination and caretaker counseling (median score: 27.5 on a 100 point scale). Children receiving care from female providers had better care than those seen by male providers (OR: 6.6, 95% CI: 2.0-21.9, P = 0.002), and doctors provided better quality of care than other providers (OR: 2.7, 95% CI: 1.1-6.4, P = 0.02). The poor were more likely to receive better care in hospitals managed by non-governmental organizations than those managed by other mechanisms (OR: 15.2, 95% CI: 1.2-200.1, P = 0.04).


CONCLUSIONS
Efforts to strengthen optimal care provision at peripheral health clinics must be complemented with investments at the referral and tertiary care facilities to ensure care continuity. The findings of improved care by female providers, doctors and NGO's for poor patients, warrant further empirical evidence on care determinants. Optimizing care quality at referral hospitals is one of the prerequisites to ensure service utilization and outcomes for the achievement of the Child health Millennium Development Goals for Afghanistan.
University of Washington School of Nursing, Seattle, WA, USA.
Allison
A
Lind
Anbrasi
A
Edward
Philippe
P
Bonhoure
Lais
L
Mustafa
Peter
P
Hansen
Gilbert
G
Burnham
David H
DH
Peters
D000346:Afghanistan; D019090:Case Management; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006282:Health Personnel / Q000145:classification / Q000592:standards*; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D008297:Male; D019370:Observation; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D011787:Quality of Health Care; D012737:Sex Factors
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