title: Care-seeking and quality of care for outpatient sick children in rural Hebei, China: a cross-sectional study.
abstract: OBJECTIVE
  To assess the quality of outpatient pediatric care provided by township and village doctors, prevalence of common childhood diseases, care-seeking behavior, and coverage of key interventions in Zhao County in China.
  
  
  METHODS
  We conducted two cross-sectional surveys: 1) maternal, newborn, and child health household survey including1601 caregivers of children younger than two years; 2) health facility survey on case management of 348 sick children younger than five years by local health workers and assessment of the availability of drugs and supplies in health facility.
  
  
  RESULTS
  Our household survey showed that the prevalence of fever, cough, and diarrhea was 16.8%, 9.2%, and 15.6% respectively. Caregivers of children with fever, cough, and diarrhea sought care primarily in village clinics and township hospitals. Only 41.2% of children with suspected pneumonia received antibiotics, and very few children with diarrhea received oral rehydration solutions (1.2%) and zinc (4.4%). Our facility survey indicated that very few sick children were fully assessed, and only 43.8% were correctly classified by health workers when compared with the gold standard. Use of antibiotics for sick children was high and not according to guidelines. CONCLUSION. We showed poor quality of services for outpatient sick children in Zhao County. Since Integrated Management of Childhood Illness strategy has shown positive effects on child health in some areas of China, it is advisable to implement it in other areas as well.
authors.affiliation: Yanfeng Zhang, Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District Beijing, 100020, P.R. China, summyzh@126.com.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhang
authors.forename: Qiong
authors.initials: Q
authors.lastname: Wu
authors.forename: Michelle Helena
authors.initials: MH
authors.lastname: van Velthoven
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Robert W
authors.initials: RW
authors.lastname: Scherpbier
mesh_terms: D017028:Caregivers; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003371:Cough / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010045:Outpatients; D015995:Prevalence; D011787:Quality of Health Care