Management of childhood illness at health facilities in Benin: problems and their causes

Am J Public Health. 2001 Oct;91(10):1625-35. doi: 10.2105/ajph.91.10.1625.


Objectives: To prepare for the implementation of Integrated Management of Childhood Illness (IMCI) in Benin, we studied the management of ill children younger than 5 years at outpatient health facilities.

Methods: We observed a representative sample of consultations; after each consultation, we interviewed caregivers and reexamined children. Health workers' performance was evaluated against IMCI guidelines. To identify determinants of performance, statistical modeling was performed and 6 focus groups with health workers were conducted to solicit their opinions.

Results: Altogether, 584 children were enrolled and 101 health workers were observed; 130 health workers participated in focus group discussions. Many serious deficiencies were found: incomplete assessment of children's signs and symptoms, incorrect diagnosis and treatment of potentially life-threatening illnesses, inappropriate prescription of dangerous sedatives, missed opportunities to vaccinate, and failure to refer severely ill children for hospitalization. Quantitative and qualitative analyses showed various health facility-, health worker-, caregiver-, and child-related factors as possible determinants of health worker performance.

Conclusions: Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Benin
  • Child Health Services / organization & administration
  • Child Health Services / standards*
  • Child, Preschool
  • Data Collection
  • Delivery of Health Care, Integrated / organization & administration*
  • Delivery of Health Care, Integrated / standards
  • Diarrhea / therapy
  • Female
  • Fever / therapy
  • Focus Groups
  • Health Facilities / standards*
  • Health Personnel / standards
  • Health Services Research
  • Humans
  • Infant
  • Malaria / therapy
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data
  • Pneumonia / therapy
  • Quality of Health Care
  • Workforce