Improving the quality of paediatric XXXX diagnosis and treatment by rural providers in Myanmar: an evaluation of a training and support intervention.

@entity1 @entity311 @entity56186
BACKGROUND: This study evaluates the effectiveness of a training programme for improving the diagnostic and treatment quality of the most complex service offered by @entity56186 ( @entity56186 ) providers, paediatric @entity311 . The study further assesses whether any quality improvements were sustained over the following 12  months. METHODS: The study took place in 13 townships in central Myanmar between January 2011 and October 2012. A total of 251 community health workers were recruited and trained in the provision of paediatric and adult @entity311 diagnosis and treatment; 197 were surveyed in all three rounds: baseline, 6 and 12  months. Townships were selected based on a lack of alterative sources of medical care, averaging 20  km from government or private professional health care treatment facilities. Seventy percent of recruits were assistant nurse midwives or had other basic health training; the rest had no health training experience. Recruits were evaluated on their ability to properly diagnosis and treat a simulated 5-year-old @entity1 using a previously validated method known as Observed Simulated @entity1 . A trained observer scored @entity56186 providers on a scale of 1-100, based on WHO and Myanmar MOH established best practices. During a pilot test, 20 established private physicians operating in @entity311 -endemic areas of Myanmar scored an average of 70/100. RESULTS: Average quality scores of newly recruited @entity56186 providers prior to training (baseline) were 12/100. Six months after training, average quality scores were 48/100. This increase was statistically significant (p  <  0.001). At 12  months after training, providers were retested and average quality scores were 45/100 (R3-R1, p  <  0.001). CONCLUSION: The @entity56186 training programme was able to improve the quality of paediatric @entity311 care significantly, and to maintain that improvement over time. Quality of care remains lower than that of trained physicians; however, @entity56186 providers operate in rural areas where no trained physicians operate. More research is needed to establish acceptable and achievable levels of quality for community health workers in rural communities, especially when there are no other care options.
