Citation, abstract, extract and comment from me below.
CITATION: Assessment of diagnostic accuracy and adherence to maternal and child health guidelines as a measure of clinical competence of frontline healthcare workers in Nigeria
O Obisesan et al.
African Journal of Reproductive Health, Vol. 26 No. 11 (2022)
Clinical competence of primary healthcare (PHC) workers is important in the delivery of maternal and child health care and services. In this cross-sectional study, we investigated the diagnostic accuracy and adherence to clinical guidelines for the management of some clinical conditions such as malaria, diarrhea, pneumonia, neonatal asphyxia and postpartum hemorrhage, as a proxy to measure the clinical competence of frontline health workers in PHCs in selected states in Nigeria. Ninety PHC facilities were randomly selected in each State and the FCT. Of the 3330 health workers, only 36.0% were able to correctly diagnose the five selected medical conditions. There was a significant difference in the diagnostic accuracy of the health workers with the doctors having highest diagnostic accuracy (65.5%) compared to other health workers (p<0.001). Adherence to the management guidelines was generally poor across all cadres of health workers and this pattern appear similar across the geopolitical regions in the country. The highest adherence to guidelines was observed among medical doctors (38.2%). The diagnostic accuracy and adherence to national guidelines for managing patients was poor among health workers, particularly, among other cadres except doctors. PHC workers in Nigeria need continuous training to enhance their clinical competence to improve quality of maternal and child health care.
'In conclusion, this study showed selected healthcare providers at the primary health care level in Nigeria demonstrated poor diagnostic accuracy of common health conditions at their respective health stations. The worst diagnostic accuracy and adherence to national guidelines was among CHEW that largely work in the primary healthcare facilities in the country. We recommend more studies that will assess different levels of competencies among frontline healthcare workers in Nigeria using both quantitative and qualitative designs to have a deeper understanding of issues around it. We also continuous training and re-training to ensure satisfactory competencies'
COMMENT (NPW): I have a couple of comments, one about this particular study and another about the cumulative evidence. With regards to this study, it's notable that the researchers measured adherence to management guidelines but without comment on the availability of guidelines and health workers' attitudes to those guidelines. It would be interesting indeed to explore more about how guidelines can be made more accessible and how to support their use and implementation. This study reminds us that huge numbers of patients are routinely vulnerable to poor quality care as a result of failure to adhere to basic guidance, and this vulnerability applies not only to those with unusual presentations, but also to the majority who present with common illnesses. Looking at the cumulative literature, HIFA did a review back in 2009 which concluded that there is 'a gross lack of knowledge about the basics on how to diagnose and manage
common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population'. https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4... We should ask 'To what extent has this situation changed?'. I invite HIFA members to share details of any papers that can help us understand these issues.
Best wishes, Neil