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Improving treatment of under five children with fever in accordance with standard guidelines in the Lake Zone of Tanzania, 2012-2014
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Over the past three years, the Tibu Homa Project (THP) has been working to improve case management of children under five with fever in the Lake Zone (Kagera, Mara, Mwanza, Geita, Shinyanga, and Simiyu regions) of Tanzania through system strengthening interventions. The Lake Zone was identified by the Ministry of Health and Social Welfare (MoHSW) and the United States Agency for International Development (USAID) because of its high under-five mortality rate, above the national average, and a high prevalence of malaria. A new adapted Integrated Management of Childhood Illness (IMCI) guideline, among other things directs treating children with fever for malaria upon laboratory evidence and guides on how to manage other malaria- negative patients for other causes of fever.
THP has been using adapted IMCI and quality improvement guidelines to train health care workers from both public and private health facilities in classrooms, conducting monthly supportive supervision and clinical mentorship visits to health facilities to achieve compliance with case management standards by assisting them to address problems in the processes of care that hinder compliance.
Trained health care workers were able to train fellow health care workers by introducing training in their routine services, making guidelines available, and conducting regular peer mentorship, case reviews, and hospital death audits. These practices, coupled with external regular supportive supervision and mentorship visits by Regional and Council Health Management Teams (RHMTs and CHMTs) and THP staff, helped to improve compliance with standard guidelines.
Assessments conducted by clinical mentors using case reviews during routine supportive supervision visits indicate that compliance to care guidelines has improved from 5% in January 2013 to 40% in March 2014 and that completion of the steps in IMCI in children with fever improved from 50% in January 2013 to 80% in March 2014. A similar trend was observed for children presenting with other IMCI conditions. The percentage of outpatient, laboratory-confirmed malaria cases (uncomplicated malaria) that received correct antimalarial drugs (such as artemisinin combination therapy) improved and remained relatively steady above 90%.
Improving health care workers’ skills through classroom teaching and on-the-job peer training, coupled by regular supportive supervision and clinical mentorship visits by RHMT and CHMT members, is critical for improving compliance with standard case management guidelines.