卢旺达儿童疾病综合管理:导师制对尼安萨和胡耶地区护理质量的影响

Alain Mirindi, A. Kayinamura, A. Ndibaza, Liliane Uwamahoro, Dieudonne Ndatimana, Ferdinand Bikorimana, Christian Mazimpaka, Richard Kalisa
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摘要

在卢旺达,保健站(HPs)是为社区提供综合初级保健服务的中间初级保健设施,距离居民家步行距离较近。我们评估了保健站提供儿童疾病综合管理(IMCI)服务的准备情况,并考察了实施儿童疾病综合管理指导计划的地区(尼安萨地区)与未实施该计划的胡耶地区之间儿童疾病综合管理服务的护理质量变化。我们开展了一项前瞻性队列研究,以评估儿童疾病综合管理指导计划实施一年后,尼安萨地区17家保健站提供的儿童疾病综合管理护理质量是否发生了变化。我们通过九个因素评估了医疗保健机构对儿童疾病综合管理的准备情况,得出了必要(所有因素)和理想(少于七个因素)的综合得分。与未接受指导的Huye地区护士相比,接受过儿童疾病综合管理指导的护士的平均理想分数(0.7-0.89)和基本分数(0.61-0.78)均有所提高。接受指导计划的护士在儿童疾病综合管理培训、服务包可用性、登记册可用性、支持性监督和基本设备可用性等因素上的得分都有所提高。在接受指导的医疗机构中,生命体征登记、危险体征检测、咳嗽识别、营养不良筛查和肺结核体征识别等方面的儿童疾病综合管理评估质量都有所提高。在扩大临床指导之前,需要解决已发现的差距,如人员配备、供应链和医疗融资。
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Integrated management of childhood illness in Rwanda: Impact of mentorship on the quality of care in Nyanza and Huye districts
In Rwanda, health posts (HPs) are intermediary primary care facilities that provide comprehensive primary care services to communities and are located at a reasonable walking distance from people's homes. We assessed the readiness of HPs for Integrated Management of Childhood Illness (IMCI) services and examined changes in the quality of care for IMCI services between districts that implemented IMCI mentorship program (Nyanza district) and Huye district which it did not.We conducted a prospective cohort study to assess whether there was change in the quality of IMCI care provided at 17 Nyanza HPs 1‐year after IMCI mentorship implementation. The readiness of HPs for IMCI was assessed across nine factors, resulting in essential (all factors) and desirable (less than seven factors) composite scores. Unpaired t‐tests were used to measure changes in IMCI quality.The HPs with IMCI mentorship had an increase in mean desirable (0.7–0.89) and essential (0.61–0.78) composite scores compared to non‐mentored HPs in Huye. The nurses who received mentorship program had improved scores in factors like IMCI training, service package availability, register availability, supportive supervision, and basic equipment availability. Quality improvements in IMCI assessments were observed in vital sign registration, danger sign detection, cough identification, malnutrition screening, and tuberculosis sign identification in the mentored HPs.Mentorship of nurses in HPs holds promise for enhancing facility readiness and IMCI service quality. Before expanding clinical mentorship, identified gaps such as staffing, supply chains, and health financing need to be addressed.
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