ABSTRACT
Aim:
To assess the overall quality of child health services provided at primary health care
facilities in the Johannesburg metropolitan area.
Objectives:
Primary Objective
To evaluate the quality of clinical care provided by health care workers caring for
children; including an assessment of the treatment of common childhood illnesses,
counselling and health promotion.
Secondary Objectives
1. To assess the quality of well baby services such as immunisation, growth promotion
and developmental monitoring.
2. To assess the availability of drug supplies and equipment.
3. To assess the quality of record keeping.
4. To describe the infrastructure available at health facilities and the availability of
services provided to children, including appropriate referral services.
Design:
This was a cross-sectional, observational study over a two-month period conducted at 16
primary health care facilities in the Johannesburg Metropolitan area; four community
health centres (CHC) and 12 primary health care (PHC) clinics. A researcher-developed
structured checklist, based on national guidelines and protocols was utilised.
Results:
A total of 141 sick child and 149 well child visits were observed. Caregivers experienced
long waiting hours (mean [SD] of 135±72 minutes). Many routine examination
procedures were poorly performed, with an appropriate diagnosis established in only 77%
of consultations. Almost half of the children (46%) received antibiotics; their use was
unwarranted in one-third of instances. Health promotion activities (such as growth
monitoring) were consistently ignored during sick child visits. The mother or sick child’s
HIV status was seldom considered or investigated. At least a third of children requiring
cotrimoxazole prophylaxis were not prescribed the antibiotic. Growth promotion and nutritional counselling at well child visits was generally inadequate with not one of 11
children requiring food supplementation receiving it. The majority of facilities were
adequately equipped and well-stocked with drugs. A lack of capacity to manage children
with chronic conditions (such as asthma), mental health problems and disabilities exists.
Conclusion:
The poor quality of care offered to children in the richest city in Africa is a sad
indictment of the inability of health service providers in the city to meaningfully address
children’s health needs. Nothing short of a deliberate and radical overhaul in the way that
health care is organised for children, with clearly defined and monitored standard clinical
practice routines, is likely to significantly change the status quo.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/5010 |
| Date | 09 July 2008 |
| Creators | Thandrayen, Kebashni |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 3341853 bytes, 43576 bytes, 351957 bytes, 3469684 bytes, 73377 bytes, 2193020 bytes, 51219 bytes, 22323 bytes, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf |
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