Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan.
OBJECTIVE
To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan.


METHODS
Mixed methods including cross-sectional study.


METHODS
Thirteen (of thirty-four) provinces in Afghanistan.


METHODS
Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities.


METHODS
Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities.


METHODS
Care of sick children according to IMCI guidelines, health worker skills and essential health system elements.


RESULTS
Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively.


CONCLUSIONS
IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness.
Health Protection and Research Organization, House P 27, Street 1. Qala-e-Fathullah, District 10, Kabul City, Afghanistan.
Ghulam Farooq
GF
Mansoor
World Health Organization, Afghanistan office: UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan.
Paata
P
Chikvaidze
United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan.
Sherin
S
Varkey
United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan.
Ariel
A
Higgins-Steele
Ministry of Public Health, Islamic Republic of Afghanistan, Great Masoud Square, Wazir Mohammad Akbar Khan, Kabul City, Afghanistan.
Najibullah
N
Safi
World Health Organization, Afghanistan office: UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan.
Adela
A
Mubasher
United Nation's Children Fund (UNICEF) Country office, UNOCA Compound, Kabul Jalalabad High Way, Kabul city, Afghanistan.
Khaksar
K
Yusufi
Ministry of Public Health, Islamic Republic of Afghanistan, Great Masoud Square, Wazir Mohammad Akbar Khan, Kabul City, Afghanistan.
Sayed Alisha
SA
Alawi
D000346:Afghanistan; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019090:Case Management / Q000458:organization & administration*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents
Afghanistan; Integrated Management of Childhood Illness (IMCI); primary health care; quality of care for sick children