Objective:To assess the clinical care of children presenting with malaria at district hospital level in a low-income African country to highlight potential areas of improvement in the quality of care of malaria.
Methods:A criteria-based clinical audit was used to assess the case-management of malaria in children under the age of five at the paediatric ward of Mangochi district hospital. As a supplement to the audit, a qualitative analysis based on in depth interviews was conducted with three health workers. Analysis of the quantitative data was performed using SPSS for Windows version 13.0.
Findings:132 patient’s records were assessed. Several crucial components that characterize good quality of care were found to be inadequate. With regard to history taking, the most poorly recorded symptoms were cough, recorded in 45 %, convulsions in 14 % and drinking/feeding in 28 %. The most important signs that the health workers failed to document were recording of seizures and neck stiffness, recorded in 6 % and 9% respectively. The malaria blood slide was only checked in 41 patients (32 %). Among the 28 patients with severe malaria a thick blood smear was checked in 46 %. Regular recording of vital signs was not done in any of the cases. The results from the audit were supported by the qualitative interviews.
Conclusion:The quality of care of children with malaria was sub-optimal compared to national standards and the WHO’s guidelines. This applied particularly to inaccurate recordings of patient’s history and nursing care, as well as inadequate clinical examination and insufficiency in laboratory testing.