Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: A cluster randomised trial in Arua district, Uganda

Marzia Lazzerini, Humphrey Wanzira, Peter Lochoro, Richard Muyinda, Giulia Segafredo, Henry Wamani, Giovanni Putoto

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Suboptimal quality of paediatric care has been reported in resource-limited settings, but little evidence exists on interventions to improve it in such settings. This study aimed at testing supportive supervision (SS) for improving health status of malnourished children, quality of case management, overall quality of care, and the absolute number of children enrolled in the nutritional services. Methods This was a cluster randomised trial conducted in Arua district. Six health centres (HCs) with the highest volume of work were randomised to either SS or no intervention. SS was delivered by to HCs staff (phase 1), and later extended to community health workers (CHWs) (phase 2). The primary outcome was the cure rate, measured at children level. Quality of case management was assessed by six pre-defined indicators. Quality of care was assessed using the national Nutrition Service Delivery Assessment (NSDA) tool. Access to care was estimated with the number of children accessing HC nutritional services. Results Overall, 737 children were enrolled. In the intervention arm, the cure rate (83.8% vs 44.9%, risk ratio (RR)=1.91, 95% CI: 1.56-2.34, p=0.001), quality of care as scored by NSDA (RR=1.57, 95% CI: 1.01-2.44, p=0.035) and correctness in complementary treatment (RR=1.52, 95% CI: 1.40-1.67, p=0.001) were significantly higher compared with control. With the extension of SS to CHWs (phase 2), there was a significant 38.6% more children accessing care in the intervention HCs (RR=1.26, 95% CI: 1.11-1.44, p=0.001) compared with control. Conclusion SS significantly improved the cure rate of malnourished children, and the overall quality of care, SS to CHWs significantly increased the crude number of children enrolled in the nutritional services. More studies should confirm these results, and evaluate the cost-effectiveness of SS.

Original languageEnglish
Article numbere001339
JournalBMJ Global Health
Volume4
Issue number4
DOIs
Publication statusPublished - Jul 1 2019

Keywords

  • children under 5 years
  • malnutrition
  • quality of care
  • randomised controlled trial
  • supportive supervision

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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