Management of common potentially serious paediatric illnesses by aid post orderlies at Tari, Southern Highlands Province

Abstract

Systematic observations were made of a small number of aid post orderlies (APOs) managing children with the common but potentially serious symptoms of cough, fever and diarrhoea. On-site performance was evaluated against recommended management guidelines set out in Dr Keith Edwards' Diagnosis and Treatment of Common Childhood Illnesses for APOs. History taking at the aid post was brief and usually non-exploratory; examination of patients was often neglected. Drug prescription was generally appropriate for the diagnosis made, but drug dosages were often incorrect and treatment principles were rarely explained to guardians. Preventive health issues were rarely tackled. Our study reaffirms the need for on-site assessment of the performance of paramedical workers, sets priority demands for continuing education of health workers, and provides a framework for competency-based problem-solving activities within this context.

PIP: This operational study of the performance of aid post orderlies (APOs) at Taril, Southern Highlands Province, Papua New Guinea, was conducted as a follow up to prior operations research workshops and specific research which highlighted the need for adequate medical care. The assessments of the clinical performance (medical history taking, examination, diagnosis, treatment, and advice) of APOs were made by a trained Huli observer in mid-1988. 86 consultations were recorded for children brought to the aid posts for complaints of cough (40), fever (24), or diarrhea (22) and seen by 7 Tari APOs. Data were evaluated by a medical officer who used the recommended Health Department reference. Diagnosis and Treatment of Common Childhood Illnesses for APOs. Results for each illness are provided. APOs made an adequate diagnosis based on the mild and self limiting symptoms, but the medical histories and examinations were too superficial to assess the severity of the illness. Sometimes the level of treatment was inappropriate, i.e., 70% of the children received appropriate cough mixtures and antimalarials for coughs, but over 50% received inadequate doses of procaine penicillin for their age. Several children were not properly referred to the hospital for management of severe dehydration. Treatments were qualitatively correct for the diagnosis made, but inappropriate doses were often prescribed. Information was rarely given to guardians on the need for repeat medications or the signs of treatment failure. There was ample opportunity to reinforce the importance of immunization, adequate nutrition, malaria control, or personal and food hygiene but APOs did not take advantage of the situation. The results reinforce the need for on-site assessment of paramedical workers who are entrusted with frontline care of patients. It has been found that APOs are often neglected by senior staff; there are complaints from APOs that they feel unappreciated by Health Department staff and the community served. Reference is made to a study of rural health services which found that only 585 of officers in charge of health centers had made any supervisory visit in the 2 months preceding the survey. In some provinces APOs sometimes are given a 1-week inservice training period a year. Structural changes, APO selection procedures, education, inservice training, supervision, and support must be addressed in order to overcome some of the apparent weaknesses in the delivery system. The emphasis is on a problem-based approach and education and continued training.