TABLE 1.
Per-Protocol Analysis of the Effect of Study Supports and Integrated Management of Childhood Illness (IMCI) Training on Case Management Quality for Ill Children During Initial Consultations at Outpatient Health Facilities in Ouémé and Plateau Departments: Benin, 1999–2004
| Outcomes for the 3 Health Worker Exposure Groups | Recommended Treatment | Recommended or Adequate Treatment | Percentage of Needed Tasks Performed per Child |
| IMCI trained with study supports | |||
| Baseline | |||
| Consultations, no. | 102 | 102 | 123 |
| Unadjusted outcome value, %a | 15.7 | 22.6 | 21.3 |
| Adjusted outcome value, %a | 15.8 | 22.0 | 21.5 |
| Follow-up | |||
| Consultations, no. | 127 | 127 | 146 |
| Unadjusted outcome value, %a | 54.3 | 55.1 | 76.6 |
| Adjusted outcome value, %a | 62.2 | 62.1 | 77.4 |
| IMCI trained with usual supports | |||
| Baseline | |||
| Consultations, no. | 106 | 106 | 119 |
| Unadjusted outcome value, %a | 21.7 | 25.5 | 24.4 |
| Adjusted outcome value, %a | 21.3 | 25.5 | 24.9 |
| Follow-up | |||
| Consultations, no. | 238 | 238 | 265 |
| Unadjusted outcome value, %a | 37.4 | 45.8 | 64.0 |
| Adjusted outcome value, %a | 40.4 | 50.3 | 65.2 |
| Not IMCI trained | |||
| Baseline | |||
| Consultations, no. | 164 | 164 | 188 |
| Unadjusted outcome value, %a | 19.5 | 27.4 | 25.6 |
| Adjusted outcome value, %a | 17.0 | 24.8 | 26.2 |
| Follow-up | |||
| Consultations, no. | 364 | 364 | 403 |
| Unadjusted outcome value, %a | 17.0 | 22.0 | 29.9 |
| Adjusted outcome value, %a | 17.1 | 22.8 | 31.8 |
| Effect sizesbc | |||
| Effect of study supports,d percentage-point change (95% CI) | 27.3* (10.8, 44.5) | 15.3 (–2.3, 33.5) | 15.5** (9.0, 22.0) |
| Effect of IMCI training,e percentage-point change (95% CI) | 19.1* (4.2, 33.5) | 26.8** (12.9, 41.3) | 34.7** (28.5, 40.9) |
| Effect of IMCI training + study supports,f percentage-point change (95% CI) | 46.4** (35.5, 62.1) | 42.1** (27.2, 59.5) | 50.2** (45.8, 54.7) |
Note. CI = confidence interval. The baseline period was 1999. The follow-up period was 2001–2004.
Columns 2 and 3 show percentages; column 4 shows mean percentages.
Based on quality of care adjusted for case complexity. In the model used to estimate the effect size for recommended treatment, the intraclass correlation coefficient was 0.094; the mean cluster size was 4.00 (1101 consultations/275 clusters); and the design effect was 1.28. In the model for recommended or adequate treatment, the intraclass correlation was 0.071; the mean cluster size was 4.00; and the design effect was 1.21. For percentage of needed tasks performed per child, the intraclass correlation was 0.388; the mean cluster size was 4.44 (1244 consultations/280 clusters); the design effect was 2.33; and the multiple R2 was 0.731.
For example, the value 27.3 for the effect of study supports equals the improvement in treatment quality provided by health workers in the IMCI-trained group receiving study supports from baseline to follow-up (i.e., 62.2%–15.8%, or 46.4 percentage points) minus the improvement in the IMCI-trained group receiving usual supports from baseline to follow-up (i.e., 40.4%–21.3%, or 19.1 percentage points). The time × study supports interaction term from the multivariate model was statistically significant, and the 95% CI of the 27.3 percentage-point effect size excluded 0 (i.e., was statistically significant).
Study supports versus usual supports for IMCI-trained health workers.
IMCI-trained health workers with usual supports versus health workers with no IMCI training.
IMCI-trained health workers with study supports versus health workers with no IMCI training. This is the sum of effects from the IMCI group receiving study supports versus the IMCI group receiving usual supports and the IMCI group receiving usual supports versus the group receiving no IMCI training.
P value of the interaction term from the multivariable regression model is between .01 and .049.
P value of the interaction term from the multivariable regression model is <.01.