Effect of Outpatient Diarrhoea Case Management Training on Prescription of Oral Rehydration Solution and Zinc Among Children Aged 2-59 Months in 3 Health Centres in Nairobi County-a Before and After Study

Abstract

Background: Diarrhoea is the second leading cause of death among children below five years globally. In 2004, the World Health Organization (WHO) introduced zinc in addition to ORS for the treatment of diarrhoea in children. This was an effort to reduce mortality from diarrhoea. However, recent studies have shown that case management of childhood diarrhoea remains poor with underutilization of both ORS and zinc in Lowand middle-income countries (LMICs). Broad objective: To determine the effect of outpatient diarrhoea case management training on health workers’ adherence to the Kenya diarrhoea guidelines among children aged 2-59 months in 3 health centres in Nairobi County. Methodology: This was a pre and post interventional study in Eastleigh Health Centre, Westlands Health Centre and Huruma Lions Health Centre. This study was built on the Nairobi pneumonia project which introduced a structured outpatient record and a mentorship project. We compared performance in the pre-intervention and postintervention periods using quality indicators in assessment, classification and treatment of diarrhoea. This was achieved by reviewing documentation of clinical practices on the structured outpatient record before and after the training. Random sampling was used to achieve a target sample size of 276 records in the pre-intervention and post-intervention periods respectively. Performance of quality indicators was dichotomized as either achieved or not achieved, in the pre-intervention and post-intervention periods with the primary effect being the absolute percentage change in performance of the quality indicators. Results: Correct prescription of zinc improved from 80% to 88% with an effect size of +7.2%, P value 0.027. Correct prescription of ORS declined from 83.7% to 81.2% with an effect size of -2.5%, P value 0.50. Correct prescription of both ORS and zinc declined from 72.1% to 71.4% with an effect size of -0.72%, P value 0.92. Adequate assessment of dehydration declined from 77.5% to 69.6% with an effect size of -8.0%, P value 0.043. Correct classification for severity of dehydration improved from 95.7% to 98.6% with an effect size of +2.9%, P value 0.076. Conclusions This study revealed that training led to an improvement on zinc prescription. Training did not have an effect on ORS prescription and combined prescription of ORS and zinc. Training was associated with a decline in adequate assessment of dehydration. Training had no effect on correct classification for severity of dehydration in the treatment of diarrhoea among children aged 2-59 months in 3 health facilities in Nairobi County. It is possible that what training could have achieved was already attained by having the structured forms (SCMFs) and mentorship.