American Journal of Epidemiology Vol. 151, No. 10: 1029-1035
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
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Predictors of Correct Treatment of Children with Fever Seen at Outpatient Health Facillities in the Central African Republic
1International Child Survival and Emerging Infections Program Support Activity, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention Atlanta, GA
2Department of Epidemiology, Rollins School of Public Health, Emory University Atlanta, GA
3Directorate of Preventive Medicine, Ministry of Population and Public Health Bangui, Central African Republic
4Deceased
Reprint requests to Dr. Alexander K. Rowe, Centers for Disease Control and Prevention, MS F22, 4770 Buford Highway, Atlanta, GA 30341 (e-mail: axr9@cdc.gov)
To identify factors associated with improved performance of health care workers who treat ill children in developing countries, the authors analyzed a sample of consultations of children with malaria (defined as any fever) from a national health facility survey conducted in the Central African Republic from December 1995 to January 1996. Twenty-eight health care workers and 204 children were studied. A univariate analysis revealed the following significant predictors of correct treatment, as defined by the Central African malaria control program: high fever (odds ratio (OR) = 3.25, 95% confidence interval (Cl): 1.47, 7.17); correct health care worker diagnosis (OR = 2.59, 95% Cl: 1.39, 4.85); and the caregiver's reporting the child’s fever to the health care worker (OR = 2.18, 95% Cl: 1.32, 3.62). There was an unexpected inverse association between the presence of a fever treatment chart and correct treatment (OR = 0.19, 95% Cl: 0.04, 0.91). Correct treatment was marginally associated with a longer consultation time (p value for trend = 0.058). Neither in-service training in the treatment of fever nor supervision was significantly associated with correct treatment. For child health programs to improve, targeted studies are needed to understand which factors, alone or in combination, improve hearth care worker performance. Am J Epidemiol 2000; 151: 1029-35.
acute disease; case management; child health services; developing countries; epidemiologic methods; malaria; primary hearth care; quality assurance, health care
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