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. 2012;7(9):e44319.
doi: 10.1371/journal.pone.0044319. Epub 2012 Sep 27.

Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria

Edward Adekola Oladele  1 , Louise Ormond, Olusegun Adeyemi, David Patrick, Festus Okoh, Olusola Bukola Oresanya, Joseph J Valadez
Affiliations

Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria

Edward Adekola Oladele et al. PLoS One. 2012.

Abstract

Background: In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system.

Methods: NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators.

Findings: LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug.

Conclusion: This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.

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Conflict of interest statement

Competing Interests: This work was partly financed by a grant from the ExxonMobil Foundation to the World Bank to support the Malaria Control Booster Project for Africa, which does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Operating Characteristic Curve for Health Facility Assessments with n = 7 and a Decision Rule of 5 for PU = 80% and PL = 50% for areas with a total of 9 and 10 health facilities.
Figure 2
Figure 2. Training received by health workers in Jigawa State, Nigeria.
Figure 3
Figure 3. Percent of health workers in Jigawa carrying out IMCI assessment.
See this image and copyright information in PMC

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