Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda

Juliet Mwanga-Amumpaire, Tobias Alfvén, Celestino Obua, Karin Källander, Richard Migisha, Cecilia Stålsby Lundborg, Grace Ndeezi and Joan Nakayaga Kalyango
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Juliet Mwanga-Amumpaire: Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
Tobias Alfvén: Department of Global Public Health, Karolinska Institutet, 171 77 Solna, Sweden
Celestino Obua: Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
Karin Källander: Department of Global Public Health, Karolinska Institutet, 171 77 Solna, Sweden
Richard Migisha: Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
Cecilia Stålsby Lundborg: Department of Global Public Health, Karolinska Institutet, 171 77 Solna, Sweden
Grace Ndeezi: Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
Joan Nakayaga Kalyango: Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda

IJERPH, 2021, vol. 18, issue 15, 1-16

Abstract: In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.

Keywords: appropriate healthcare; primary level; private; pediatrics; infections (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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