International Journal of Epidemiology 2003;32:296-303
© International Epidemiological Association 2003
Infectious Diseases |
Risk and protective factors for two types of error in the treatment of children with fever at outpatient health facilities in Benin
1 Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Direction Départementale de la Santé Publique de l’Ouémé, Benin.
3 Africare-Benin, Porto Novo, Benin.
Correspondence: Alexander K Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341–3724, USA. E-mail: axr9{at}cdc.gov
Background In developing countries, health workers often do not follow clinical practice guidelines. However, few studies have examined why different types of errors occur.
Methods We analysed a sample of consultations of children with non-severe malaria (defined as fever without signs of severe illness) from a health facility survey conducted in Ouémé Département, Benin. Treatment was defined as correct (recommended antimalarial), a minor error (non-recommended antimalarial), or a major error (no antimalarial).
Results In all, 85 health workers and 289 children were studied. In a multivariate logistic regression analysis, the following factors were significantly associated with major errors: treatment by a physician (adjusted odds ratio [aOR] = 13.57, 95% CI: 1.45–126.75), child’s age <12 months (aOR = 3.41, 95% CI: 1.15–10.07), and child’s temperature (aOR = 0.58 per °C, 95% CI: 0.34–0.97). Factors significantly associated with minor errors were: child’s temperature (aOR = 1.43 per °C, 95% CI: 1.07–1.92), electricity at the health facility (aOR = 3.10, 95% CI: 1.05–9.17), 
1 supervision visit in the past 6 months (aOR = 0.33, 95% CI: 0.14–0.77), fever treatment wall chart in the consultation room (aOR = 0.29, 95% CI: 0.12–0.73), and number of non-fever chief complaints (aOR = 0.67 per complaint, 95% CI: 0.48–0.93). In-service training in malaria treatment was not significantly associated with either error type.
Conclusions Many factors may influence health worker performance, and factors such as pre-service training may influence performance in unexpected ways. Identifying different errors and analysing them separately can help reveal potential causes that may be masked by combining errors into a single category.
Keywords Health services research, developing countries, Benin, malaria, child health services, epidemiological methods
Accepted 4 December 2002
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