RT Journal Article
SR Electronic
T1 Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 565
OP 570
DO 10.1136/archdischild-2013-305863
VO 100
IS 6
A1 Hema Magge
A1 Manzi Anatole
A1 Felix Rwabukwisi Cyamatare
A1 Catherine Mezzacappa
A1 Fulgence Nkikabahizi
A1 Saleh Niyonzima
A1 Peter C Drobac
A1 Fidele Ngabo
A1 Lisa R Hirschhorn
YR 2015
UL http://adc.bmj.com/content/100/6/565.abstract
AB 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. Design 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). Setting 21 rural health centres in Rwanda. Outcomes 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.