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BACKGROUND: Evaluations of the guidelines for the management of Lower Respiratory Tract Infections (LRTI) Sub-Saharan Africa, particularly in Tanzania is scant. AIM: The aim of the study was to assess the usefulness of the current Tanzanian treatment guideline for the management lower respiratory tract infection. SUBJECTS AND METHODS: A descriptive cross sectional study in 11 hospitals of different levels in the Kilimanjaro region Data were collected from May 2012 to July 2012 by semi-structured interview for clinicians using 2 dummy cases for practical assessment. Data were analyzed by STATA v11 (StataCorp, TX, USA). Qualitative narratives from the interviews were translated, transcribed then coded by colors into meaningful themes. RESULTS: A variety of principles for diagnosing and managing LRTI were demonstrated by 53 clinicians of Kilimanjaro. For the awareness, 67.9% (36/53) clinicians knew their responsibility to use Standard Treatment Guideline for managing LRTI. The content derived from Standard Treatment Guideline could be cited by 11.3% of clinicians (6/53) however they all showed concern of gaps in the guideline. Previous training in the management of patients with LRTI was reported by 25.9% (14/53), majority were pulmonary TB related. Correct microorganisms causing different forms of LRTI were mentioned by 11.3% (6/53). Exact cause of Atypical pneumonia and Q fever as an example was stated by 13.0% (7/53) from whom the need of developing the guideline for LRTI was explicitly elaborated. CONCLUSION: The current guidelines have not been used effectively for the management of LRTI in Tanzania. There is a need to review its content for the current practical use.
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BACKGROUND: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. AIM: The aim of this study is to assess the performance of health workers for neonatal health-care. MATERIALS AND METHODS: Settings - Peripheral health facilities (regional referral, district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region, Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26(th) November, 2010 to 25(th) April, 2011. We analyzed our quantitative data by using STATA v10 (StataCorp, TX, USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables. RESULTS: Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4% (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5% (67/140). In the periphery (40), first comment was on management and follow-up of neonatal cases 47.5% (19/40), second on a need of skills 45% (18/40) and third on timely referrals 7.5% (18/40). Shortage of proper equipment was reported at 26.4% (37/140), shortage of staff was reported at 12.0% (17/140), lack of organization of care 11.4% (16/140) and poor hygiene at 2.9% (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95% confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson χ(2) [2] = 53.8; P < 0.001). CONCLUSION: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation.
RESUMEN
Background: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. Aim: The aim of this study is to assess the performance of health workers for neonatal health-care. Materials and Methods: Settings - Peripheral health facilities (regional referral; district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region; Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26 th November; 2010 to 25 th April; 2011. We analyzed our quantitative data by using STATA v10 (StataCorp; TX; USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables. Results: Birth asphyxia was the most recalled health problem requiring critical care; reported by 27.5 (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4 (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5 (67/140). In the periphery (40); first comment was on management and follow-up of neonatal cases 47.5 (19/40); second on a need of skills 45 (18/40) and third on timely referrals 7.5 (18/40). Shortage of proper equipment was reported at 26.4 (37/140); shortage of staff was reported at 12.0 (17/140); lack of organization of care 11.4 (16/140) and poor hygiene at 2.9 (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95 confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson ?2 [2] = 53.8; P 0.001). Conclusion: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation