title: Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda.
abstract: OBJECTIVE
  Integrated Management of Childhood Illness (IMCI) is the leading clinical protocol designed to decrease under-five mortality globally. However, impact is threatened by gaps in IMCI quality of care (QOC). In 2010, Partners In Health and the Rwanda Ministry of Health implemented a nurse mentorship intervention Mentoring and Enhanced Supervision at Health Centres (MESH) in two rural districts. This study measures change in QOC following the addition of MESH to didactic training.
  
  
  METHODS
  Prepost intervention study of change in QOC after 12 months of MESH support measured by case observation using a standardised checklist. Study sample was children age 2 months to 5 years presenting on the days of data collection (292 baseline, 413 endpoint).
  
  
  METHODS
  21 rural health centres in Rwanda.
  
  
  RESULTS
  Primary outcome was a validated index of key IMCI assessments. Secondary outcomes included assessment, classification and treatment indicators, and QOC variability across providers. A mixed-effects regression model of the index was created.
  
  
  RESULTS
  In multivariate analyses, the index significantly improved in southern Kayonza (β-coefficient 0.17, 95% CI 0.12 to 0.22) and Kirehe (β-coefficient 0.29, 95% CI 0.23 to 0.34) districts. Children seen by IMCI-trained nurses increased from 83.2% to 100% (p<0.001) and use of IMCI case recording forms improved from 65.9% to 97.1% (p<0.001). Correct classification improved (56.0% to 91.5%, p<0.001), as did correct treatment (78.3% to 98.2%, p<0.001). Variability in QOC decreased (intracluster correlation coefficient 0.613-0.346).
  
  
  CONCLUSIONS
  MESH was associated with significant improvements in all domains of IMCI quality. MESH could be an innovative strategy to improve IMCI implementation in resource-limited settings working to decrease under-five mortality.
authors.forename: Hema
authors.initials: H
authors.lastname: Magge
authors.forename: Manzi
authors.initials: M
authors.lastname: Anatole
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Partners In Health, Boston, Massachusetts, USA.
authors.forename: Felix Rwabukwisi
authors.initials: FR
authors.lastname: Cyamatare
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Partners In Health, Boston, Massachusetts, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mezzacappa
authors.affiliation: Rwanda Ministry of Health, Kigali, Rwanda.
authors.forename: Fulgence
authors.initials: F
authors.lastname: Nkikabahizi
authors.affiliation: Rwanda Ministry of Health, Kigali, Rwanda.
authors.forename: Saleh
authors.initials: S
authors.lastname: Niyonzima
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda Partners In Health, Boston, Massachusetts, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Drobac
authors.affiliation: Rwanda Ministry of Health, Kigali, Rwanda.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D008611:Mentors; D058996:Quality Improvement; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*; D012432:Rwanda
keywords: General Paediatrics; Health services research; Nursing Care