Assessing healthcare provider competencies to diagnose and treat children under-5 years of age with acute disease in Central Mozambique

Abstract

BackgroundIt is often assumed that poor quality of medical care is due to a lack of knowledge and skills; however, evidence demonstrates that health care providers do not always apply the knowledge and skills that they know. Here we further explore this area, first by describing competencies of providers in diagnosing and managing children under-5 years of age with severe disease in central Mozambique, and second by examining how health facility and provider characteristics are associated with clinicians’ performance. MethodsWe conduct a cross-sectional analysis of an annual longitudinal health facility survey as part of provider competencies were assessed through direct observation of patient interactions with 122 maternal and child health (MCH) nurses, and a further 416 clinical vignettes with health care providers (including MCH nurses and mid-level clinical officers). Data were collected by experienced and trained health professionals using standardized instruments adapted from the national pediatric protocols for integrated management of childhood illnesses. To identify predictors associated with overall provider competence we performed a mixed-methods logistic regression with random intercepts for provider and variables (Table 1). Results Providers’ theoretical application of national pediatric guidelines was high, with 93% and 100% of providers correctly identifying clinical danger sign in the two vignettes, respectively. Overall, application of clinical guidelines in patient encounters was low, with less than 20% of the providers assessing any of the danger signs. In the mixed-methods logistic regression, clinical and preventive technicians were associated with 39% fewer odds of correctly identifying any danger sign when comparing to MCH nurses. ConclusionsWhile provider knowledge of clinical guidelines in identifying signs of illness and disease severity was found to be high, their application in the clinical setting was low. MCH nurses were more likely to correctly identify danger signs in children during directly observed clinical visits. Interventions to improve the quality of pediatric care should address not only observed knowledge differences among cadres, but importantly, the gap between health worker knowledge of clinical guidelines and their application. Further research is needed to identify drivers, beyond training, of clinical guideline adoption across health provider cadres.