A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin

• Published in: American journal of public health (1971) Vol. 99; no. 5; pp. 837 - 846
• Main Authors: Rowe, Alexander K, Onikpo, Faustin, Lama, Marcel, Osterholt, Dawn M, Rowe, Samantha Y, Deming, Michael S
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01-05-2009; American Public Health Association
• Subjects: Adolescent; Benin; Biological and medical sciences; Case management; Child; Child mortality; Child, Preschool; Children & youth; Clinical medicine; Confidence Intervals; Design; Developing countries; Developing Countries - statistics & numerical data; Evidence-Based Practice - statistics & numerical data; Female; General aspects; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Health Care Surveys; Health facilities; Health Personnel - statistics & numerical data; Hospitals; Humans; Illnesses; Infant; Infant, Newborn; Intervention; LDCs; Logistic Models; Malaria; Male; Medical sciences; Miscellaneous; Mortality; Pediatrics - standards; Pediatrics - statistics & numerical data; Practice Guidelines as Topic; Program Development; Program Evaluation; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care - standards; Research and Practice; Supervision; Supervisors; Training; Workers; Workshops; World Health Organization; Benin; Africa; Human; Improvement; Compliance; Managed care; Health worker; Child; Recommendation; Public health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2008.134411

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.
We conducted a randomized trial in Benin. We administered 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.
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 < .05), and both groups outperformed untrained workers.
IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.