title: Measuring pediatric quality of care in rural clinics-a multi-country assessment-Cambodia, Guatemala, Zambia and Kenya.
abstract: OBJECTIVE
  To assess the quality of care provided in rural pediatric facilities in Cambodia, Guatemala, Kenya and Zambia DESIGN: All public health facilities in four districts in each country were included in the assessment. Based on utilization patterns, five children under five were selected randomly from each facility to perform the Integrated Management of Childhood Illness (IMCI) assessments followed by exit interviews with their caretakers.
  
  
  METHODS
  Seventy rural ambulatory pediatric care facilities.
  
  
  METHODS
  Three hundred and forty pediatric case management observations and exit interviews with child caretakers.
  
  
  METHODS
  IMCI index of observed quality of care for patient assessment and counseling RESULTS: Screening for danger signs, diarrhea and fever showed significant differences between countries (P < 0.001), with facilities in Cambodia and Guatemala performing better. More than 90% of the children were screened for fever in all three countries, but <75% were screened in Cambodia. The assessment of nutritional status, checking weight against growth chart and palmar pallor for anemia, was suboptimal in all countries. Mean consultation time ranged from 8.2 minutes in Zambia and 12.6 minutes in Guatemala. Child age, consultation time, health provider cadre and presenting symptoms were significantly associated with higher quality of assessment and counseling care as measured by the IMCI index.
  
  
  CONCLUSIONS
  Achieving the goals of universal health coverage in these contexts must be complimented with accelerated efforts for capacity investments at the primary care level to ensure optimal quality of healthcare and favorable health outcomes for children, who still experience a high disease burden for these common IMCI conditions.
authors.affiliation: Department of International Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
authors.forename: Anbrasi
authors.initials: A
authors.lastname: Edward
authors.affiliation: Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Dam
authors.affiliation: Global Health, 300 I Street NE, Washington, DC 20002, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Chege
authors.affiliation: Global Health, 300 I Street NE, Washington, DC 20002, USA.
authors.forename: Annette E
authors.initials: AE
authors.lastname: Ghee
authors.affiliation: Department of International Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Zare
authors.affiliation: National Institute of Public Health, #2, St 289, Toul Kork district, Phnom Penh, Cambodia.
authors.forename: Chea
authors.initials: C
authors.lastname: Chhorvann
mesh_terms: D000554:Ambulatory Care Facilities; D002160:Cambodia; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D006166:Guatemala; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D007630:Kenya; D019370:Observation; D010290:Parents; D011787:Quality of Health Care; D019035:Rural Health Services
keywords: IMCI; child health; quality of care; rural clinics