Table 1.
Health System Characteristics and Content of Care during Sick Child Visits in Nine Low‐ and Middle‐Income Countries (N = 15,444)
| Haiti 2013 | Kenya 2010 | Malawi 2013 | Namibia 2009 | Nepal 2014 | Rwanda 2007 | Senegal 2013–2015 | Tanzania 2015 | Uganda 2007 | Nine Country Average | |
|---|---|---|---|---|---|---|---|---|---|---|
| Country characteristics a | ||||||||||
| Under‐5 mortality per 1,000 live births | 73.1 | 62.2 | 68.7 | 58.6 | 38.0 | 89.5 | 55.5 | 58.8 | 100.5 | NA |
| Physicians per 100,000 | – | 17.7 | 1.9 | 37.4 | – | 5.5 | 5.9 | 3.0 | 11.7 | NA |
| Gross domestic product per capita (2010 USD) | 718.4 | 967.3 | 471.8 | 4,978.7 | 675.7 | 482.1 | 1,007.4 | 836.0 | 538.0 | NA |
| Facility characteristics | ||||||||||
| Facilities | 509 | 442 | 674 | 275 | 481 | 371 | 819 | 885 | 261 | 4,717 |
| Service readinessb (mean ± SD) | 60% ± 16% | 58% ± 16% | 58% ± 16% | 73% ± 8% | 49% ± 14% | 64% ± 12% | 63% ± 10% | 49% ± 17% | 45% ± 16% | 58% ± 16% |
| Patients per provider (Median [IQR])c | 5 (3–9) | 5 (3–10.5) | 13 (6–25) | 5 (3–7) | 3 (2–5) | 6 (4–10) | 5 (3–7) | 5 (3–6) | 6 (3–10) | 5 (3–9) |
| Sick child visit characteristics | ||||||||||
| Sick child visits observed | 1,617 | 1,291 | 2,437 | 1,084 | 1,322 | 1,210 | 2,502 | 3,333 | 648 | 15,444 |
| % at private facility | 60% | 24% | 22% | 12% | 16% | 35% | 17% | 16% | 9% | 24% |
| % at hospital | 35% | 24% | 35% | 6% | 38% | 5% | 6% | 12% | 8% | 19% |
| Age | ||||||||||
| <2 months | 8% | 1% | 3% | 3% | 5% | 4% | 6% | 4% | 3% | 4% |
| 2–11 months | 31% | 28% | 34% | 28% | 26% | 31% | 33% | 35% | 34% | 31% |
| 12–59 months | 61% | 71% | 62% | 69% | 69% | 65% | 61% | 61% | 63% | 65% |
| % with provider typed | ||||||||||
| MDs | 69% | 2% | 1% | 4% | 35% | 6% | 10% | 3% | 1% | 14% |
| Associate clinicianse | NA | 34% | 86% | NA | 55% | NA | 31% | 62% | 39% | 34% |
| RNs | 14% | 17% | 1% | 40% | 10% | 2% | 24% | 8% | 4% | 13% |
| Other nursesj | 17% | 46% | 13% | 56% | 0% | 92% | 35% | 27% | 57% | 38% |
| % where child is severely illf | 16% | 21% | 8% | 9% | 8% | 12% | 5% | 9% | 14% | 11% |
| Diagnosis | ||||||||||
| None | 7% | 1% | 1% | 6% | 9% | 3% | 3% | 3% | 1% | 4% |
| Diarrhea, digestive disorder, dehydration | 14% | 4% | 10% | 9% | 18% | 7% | 18% | 11% | 1% | 10% |
| Fever, malaria | 10% | 16% | 18% | 4% | 17% | 14% | 3% | 25% | 21% | 14% |
| Respiratory illness | 17% | 26% | 40% | 41% | 23% | 11% | 29% | 28% | 14% | 26% |
| More than one of the above | 14% | 46% | 13% | 23% | 3% | 59% | 6% | 20% | 58% | 27% |
| Other (e.g., ear infection) | 38% | 8% | 18% | 16% | 29% | 6% | 41% | 14% | 5% | 19% |
| % where caretaker is very satisfied with care receivedi | 92% | 79% | 82% | 75% | 42% | NA | 91% | 74% | NA | 76% |
| Caretaker knowledge on exitg (mean ± SD) | 41% ± 25% | 42% ± 24% | 34% ± 21% | 33% ± 30% | 40% ± 25% | 21% ± 28% | 38% ± 25% | 38% ± 21% | 41% ± 36% | 37% ± 27% |
| Visit characteristics | ||||||||||
| Duration of visit in minutes (N = 12,825) Median (IQR) | 10 (6–13) | 8 (5–13) | 6 (4–14) | 10 (7–14) | 6 (4–9) | 6 (5–10) | 9 (7–13) | 12 (8–19) | 6 (4–10) | 8 (5–12) |
| Content of care (max 24 items) N (%)h | 7.7 (32%) | 10.4 (43%) | 6.8 (28%) | 11.6 (49%) | 6.3 (26%) | 7.8 (33%) | 7.7 (32%) | 7.2 (30%) | 10.6 (45%) | 8.4 (35%) |
| History items (max 9) | 3.0 (33%) | 4.4 (49%) | 2.9 (32%) | 4.5 (51%) | 2.6 (29%) | 3.0 (34%) | 3.0 (34%) | 3.8 (43%) | 5.0 (56%) | 3.6 (40%) |
| Examination items (max 10) | 3.6 (36%) | 3.8 (38%) | 2.3 (23%) | 4.5 (45%) | 2.3 (23%) | 3.5 (36%) | 3.4 (34%) | 2.1 (21%) | 3.7 (37%) | 3.3 (33%) |
| Counseling items (max 5) | 1.1 (23%) | 2.2 (44%) | 1.6 (31%) | 2.6 (53%) | 1.3 (26%) | 1.3 (26%) | 1.3 (26%) | 1.2 (25%) | 1.9 (39%) | 1.6 (33%) |
From World Development Indicators using data from year of health facility survey or closest available year.
Facility service readiness index calculated as average performance in five domains (basic amenities, basic equipment, infection control measures, diagnostics, medication) as defined by the World Health Organization.
Calculated as total patients observed on day of assessment over total staff directly observed providing sick childcare.
Not all provider type options are available in every country.
Associate clinicians include advanced practice clinicians (e.g., assistant medical officers) and paramedical (e.g., clinical officers).
Severe illness is defined as child with recent convulsions or child refusing food and vomiting everything.
Caretaker knowledge based on response to five items on exit interview: child's diagnosis, danger signs requiring return, plan for follow‐up visit, and (for those with medication prescribed) how to give medication and appropriate dose.
Content of care is the sum of history, examination, and counseling items. Percent is average number of items completely divided by the maximum.
Nepal was the only country to offer five response options for satisfaction: very satisfied, fairly satisfied, neutral, fairly dissatisfied, very dissatisfied. All other surveys offered three options: very satisfied, more or less satisfied, not satisfied.
Includes enrolled nurses and nursing aides and infrequently pharmacy and other technicians, community health agents and other non‐clinical staff.