title: Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria.
abstract: BACKGROUND
  In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system.
  
  
  METHODS
  NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators.
  
  
  RESULTS
  LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug.
  
  
  CONCLUSIONS
  This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
authors.forename: Edward Adekola
authors.initials: EA
authors.lastname: Oladele
authors.forename: Louise
authors.initials: L
authors.lastname: Ormond
authors.forename: Olusegun
authors.initials: O
authors.lastname: Adeyemi
authors.forename: David
authors.initials: D
authors.lastname: Patrick
authors.forename: Festus
authors.initials: F
authors.lastname: Okoh
authors.forename: Olusola Bukola
authors.initials: OB
authors.lastname: Oresanya
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Valadez
mesh_terms: D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D055810:Lot Quality Assurance Sampling; D008288:Malaria; D008297:Male; D009549:Nigeria; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*