TABLE 4—
Statistically Significant (P < .05) Predictors of Health Workers' Performance in the Management of Childhood Illness at Outpatient Health Facilities in Ouémé Département, Benin
| Outcomes and Predictorsa (No. of Children in Analysis) | No. (%) of Children With the Outcome | % of Children With the Outcome for Each Level of the Predictor | Adjusted OR (95% CI) | P |
| Outcome 1. Health worker pinches skin to assess dehydration for children with diarrhea (n = 52) | 7 (13.5) | |||
| In-service diarrhea training (trained health workers vs untrained health workers) | 41.7 vs 5.0 | 12.4 (1.8, 83.9) | .01 | |
| Outcome 2. ORS treatment for children with diarrhea (n = 52) | 20 (38.5) | |||
| Chief complaint of diarrhea (yes vs no) | 73.3 vs 24.3 | 9.9 (2.7, 36.3) | .0006 | |
| Child's sex (male vs female) | 42.9 vs 33.3 | 5.3 (1.2, 23.7) | .03 | |
| Health worker type (nursing aide vs nurse vs physician)b | 57.1 vs 37.5 vs 20.0 | 3.5 (1.2, 9.9) | .02 | |
| Outcome 3. Iron treatment for children with IMCI-defined nonsevere anemia who did not need urgent referral (n = 100) | 48 (48.0) | |||
| Health worker diagnosed anemia (diagnosed vs not diagnosed) | 81.0 vs 39.2 | 7.9 (1.9, 33.8) | .005 | |
| Child's temperature (≥38.5°C vs <38.5°C) | 26.7 vs 57.1 | 0.24 (0.1, 0.6) | .004 | |
| Outcome 4. Effective oral antibiotic treatment for children with IMCI-defined nonsevere pneumoniac (n = 117) | 66 (56.4) | |||
| Health worker had knowledge of pneumonia treatment (yes vs no)d | 65.1 vs 32.3 | 5.1 (2.0, 12.9) | .0007 | |
| Child's age (per year increase, ranging from 0 to 4 years)b | … | 0.7 (0.5, 0.9) | .02 | |
| Consultation length (≥15 min vs 10–14 min vs <10 min)b | 75.0 vs 55.3 vs 33.3 | 3.2 (1.8, 5.6) | <.0001 | |
| Outcome 5. Referral for hospitalization for children with an IMCI-defined need for urgent referral (n = 70) | 23 (32.9) | |||
| Health facility had an inpatient service (yes vs no) | 51.6 vs 17.9 | 15.6 (3.0, 81.0) | .001 | |
| Child was lethargic or unconscious (yes vs no) | 75.0 vs 24.1 | 5.2 (1.1, 25.4) | .04 | |
| Case load (per additional patient, ranging from 2 to 34 patients)b | … | 0.9 (0.8, 0.96) | .005 | |
| Health worker's age (per year increase, ranging from 25 to 52 years)b | … | 0.9 (0.8, 0.97) | .01 | |
| Outcome 6. DPT vaccination for children needing DPT who did not need urgent referral (n = 53) | 13 (24.5) | |||
| Child's age (<1 y vs ≥1 y)e | 35.1 vs 0 | Undefined | .005 | |
| Outcome 7. Unnecessary injections (health worker prescribed at least 1 injection not recommended by IMCI guidelines) (n = 397) | 120 (30.2) | |||
| Child's temperature (≥38.5°C vs <38.5°C) | 53.8 vs 23.2 | 2.9 (1.7, 5.0) | <.0001 | |
| Health worker's diagnosis was malaria (yes vs no) | 35.8 vs 21.4 | 1.8 (1.1, 3.0) | .01 |
Note. OR = odds ratio; CI = confidence interval; ORS = oral rehydration solution; IMCI = Integrated Management of Childhood Illness; DPT = diphtheria-pertussis-tetanus.
aVariables examined are child's age, sex, chief complaints, temperature, and treatment with an antimalarial before being brought to the health facility; consultation length; health worker's age, sex, preservice and in-service training, knowledge, diagnostic accuracy, case load, and supervision in the past 6 months; health facility type (small government health facility, large government health facility, or nongovernment health facility); and whether the health facility had an inpatient service, a resident supervisor, wall charts in the consultation room, and medicines in stock. Most, but not all, variables in this list were analyzed as potential predictors for the 7 outcomes examined.
bVariable analyzed as a continuous variable; the odds ratio and P value reflect a test for trend.
cEffective oral antibiotics are amoxicillin, ampicillin, cotrimoxazole, and erythromycin.
dKnowledge of pneumonia treatment means that when the health worker was asked for the treatment of a child who had fever, cough, and fast breathing in a hypothetical case scenario, the health worker's response included amoxicillin, ampicillin, cotrimoxazole, or erythromycin.
eBecause a proportion equaled zero, the variable was analyzed with 2-sided Fisher exact test.