Standard Case Management and antibiotic use in Acute Respiratory Infections in Children <5 years; ARIC Health center level in Region, 10 2004

Abstract

           The objective of this study is to study Health center and officer quality in Standard Case Management. This includes the antibiotic use in order to cure Acute Respiratory Infections in Children (ARIC) in public health center level. Six provinces were randomly selected to do the cross-sectional study which consists of Chiangmai, Chiangrai, Lam pang, Lamphoon, Payao and Mae Hong Son. In these 6 provinces, there were 248 heath center officers and 10 patients at each health center (2,459 patients in total). Research tools are interviews and history record between June-September 2004. The study found that the public health centers are able to provide a standard case management. They have sufficient antibiotics and necessary medicines and patient history record system to support the nursing. In addition, 79.4% of random public health center have enough fundamental educational tools such as ARIC-SCM chart. For the quality of service, health center officers are able to investigate symptom, judge and treat ARIC disease but, unfortunately, do not reach the level of standard indicator. From physical examination record of 2,459 children, the percentage of the record separated by physical examination type are as follow; 38.9% (0-79.3) of the whole sample measured respiratory rate, 65.7% (6.5-97.3) measured if there is intercostal retraction, 80.6% (59.2-97.3) measured body temperature, 76.2% (53.9-100) measured body weight and 62.5% (6.5-97.3) use stamp to help investigate symptom. For officer's knowledge to provide standard case management, 248 health center officers are well educated to indicate early warning sign of severe symptom, treat a patient from cold and pneumonia; and advice parent about the first aid. The ability to treat mastoiditis and sore throat is rather low to moderate around 22.2-75.0%. Antibiotic use to cure ARIC disease observed in 2,459 samples was over used for 20.9%. Overall, the findings indicate that public health centers are well-prepared to provide standard case management. However, the quality of officer's service to provide the standard case management and knowledge has to be immediately improved. Last but not least, overuse of antibiotics for ARIC treatment compared to the standard of World Health Organization (WHO) is found in some provinces.