Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda

• Published in: Archives of disease in childhood 2015-06, Vol.100 (6), p.565-570
• Main Authors: Magge, Hema, Anatole, Manzi, Cyamatare, Felix Rwabukwisi, Mezzacappa, Catherine, Nkikabahizi, Fulgence, Niyonzima, Saleh, Drobac, Peter C, Ngabo, Fidele, Hirschhorn, Lisa R
• Format: Article
• Language: English
• Subjects: Algorithms; Attrition (Research Studies); Care and treatment; Check Lists; Child; Child Health Services - organization & administration; Child, Preschool; Children; Correlation coefficient; Data collection; Delivery of Health Care, Integrated - methods; Delivery of Health Care, Integrated - organization & administration; Delivery Systems; Diseases; Female; Health facilities; Health Personnel; Health Services Research; Humans; Illnesses; Infant; Intervention; Male; Medical care; Medical care (Private); Medical personnel; Mentors; Mortality; Nurses; Observation; Pediatric diseases; Quality Improvement; Quality management; Risk factors; Rural Health Services - organization & administration; Rural Population - statistics & numerical data; Rwanda; Sample Size; Supervision; Teaching Methods
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2013-305863

Objective Integrated Management of Childhood Illness (IMCI) is the leading clinical protocol designed to decrease under-five mortality globally. However, impact is threatened by gaps in IMCI quality of care (QOC). In 2010, Partners In Health and the Rwanda Ministry of Health implemented a nurse mentorship intervention Mentoring and Enhanced Supervision at Health Centres (MESH) in two rural districts. This study measures change in QOC following the addition of MESH to didactic training. Design Prepost intervention study of change in QOC after 12 months of MESH support measured by case observation using a standardised checklist. Study sample was children age 2 months to 5 years presenting on the days of data collection (292 baseline, 413 endpoint). Setting 21 rural health centres in Rwanda. Outcomes Primary outcome was a validated index of key IMCI assessments. Secondary outcomes included assessment, classification and treatment indicators, and QOC variability across providers. A mixed-effects regression model of the index was created. Results In multivariate analyses, the index significantly improved in southern Kayonza (β-coefficient 0.17, 95% CI 0.12 to 0.22) and Kirehe (β-coefficient 0.29, 95% CI 0.23 to 0.34) districts. Children seen by IMCI-trained nurses increased from 83.2% to 100% (p