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A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin

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  • Rowe, A.K.
  • Onikpo, F.
  • Lama, M.
  • Osterholt, D.M.
  • Rowe, S.Y.
  • Deming, M.S.

Abstract

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. Methods.We conducted a randomized trial in Benin.Weadministered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P

Suggested Citation

  • Rowe, A.K. & Onikpo, F. & Lama, M. & Osterholt, D.M. & Rowe, S.Y. & Deming, M.S., 2009. "A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin," American Journal of Public Health, American Public Health Association, vol. 99(5), pages 837-846.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2008.134411_2
    DOI: 10.2105/AJPH.2008.134411
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    Cited by:

    1. Marzia Lazzerini & Venera Shukurova & Marina Davletbaeva & Kubanychbek Monolbaev & Tatiana Kulichenko & Yuri Akoev & Maya Bakradze & Tea Margieva & Ilya Mityushino & Leyla Namazova-Baranova & Elnura B, 2017. "Improving the quality of hospital care for children by supportive supervision: A cluster randomized trial, Kyrgyzstan," WIDER Working Paper Series wp-2017-140, World Institute for Development Economic Research (UNU-WIDER).
    2. Lange, Siri & Mwisongo, Aziza & Mæstad, Ottar, 2014. "Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?," Social Science & Medicine, Elsevier, vol. 104(C), pages 56-63.
    3. Duyen Thi Kim Nguyen & Karen K Leung & Lynn McIntyre & William A Ghali & Reg Sauve, 2013. "Does Integrated Management of Childhood Illness (IMCI) Training Improve the Skills of Health Workers? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-1, June.
    4. Kathleen Anne Holloway & Laura Rosella & David Henry, 2016. "The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-12, March.

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