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BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement

Authors: Ashwin Vasan, Manzi Anatole, Catherine Mezzacappa, Bethany L Hedt-Gauthier, Lisa R Hirschhorn, Fulgence Nkikabahizi, Marc Hagenimana, Aphrodis Ndayisaba, Felix R Cyamatare, Bonaventure Nzeyimana, Peter Drobac, Neil Gupta

Published in: BMC Health Services Research | Issue 1/2013

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Abstract

Background

As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda.

Methods

Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard.

Results

Four hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively).

Conclusion

Fundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care.
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Metadata
Title
Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement
Authors
Ashwin Vasan
Manzi Anatole
Catherine Mezzacappa
Bethany L Hedt-Gauthier
Lisa R Hirschhorn
Fulgence Nkikabahizi
Marc Hagenimana
Aphrodis Ndayisaba
Felix R Cyamatare
Bonaventure Nzeyimana
Peter Drobac
Neil Gupta
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-518

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