ABSTRACT
In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern Brazil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed in the facilities were lack of information on target population and coverage, lack of equipment to permit rehydration in the premises, and frequent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling information given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration, but 90% were sent home immediately and not kept in the facilities to practice rehydration under guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The study showed that oral rehydration therapy is well established in the government health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case management and health education.
PIP: The 9 states in the northeast of Brazil were divided into 4 groups based on population size and geographical distribution. In the capital cities of each state, 5-8 health units treating children with diarrhea were chosen at random. Overall, 78 health care units were studied. University-trained nurses evaluated each health care unit regarding diarrhea management and conducted interviews using questionnaires for the data collection. The survey team was split into groups of 4, each group covering 1 state. The field-work was carried out in May 1989 and took 4-6 weeks to complete. 88% of facilities surveyed were health centers, while the rest were outpatient departments in hospitals. In 40% of the facilities, the number of monthly consultations of children was known, while only 22% had information on the number of children attending for diarrhea each month. 62% of facilities had a special oral rehydration therapy (ORT) place for children. Utensils for administration of ORT were available in only half of the facilities. In 1/5 of the facilities the sugar-salt-solution packets were never or seldom available. In 32 of 65 facilities, the most recent shipment of ORS packets had arrived in the last month. 10 facilities had not received ORS for more than 6 months. In 67 facilities (86%) a physician, and in 9 a health auxiliary, was responsible for managing childhood diarrhea. 75 visits for childhood diarrhea were observed in 42 health facilities. 58 of the attendances (77%) were managed by doctors, 12 by health auxiliaries, and 5 by nurses. 90% of the patients were sent home, while the rest were treated. In 84% of cases oral rehydration therapy was prescribed, usually oral rehydration salts (ORS). Antimicrobial drugs were prescribed in 21% of the cases. Other drugs like metochlopramide, caolin-pectin, aspirin and vitamins were prescribed in 41% of the cases.
