A national survey of private-sector outpatient care of sick infants and young children in Nepal

Ban, Bharat; Hodgins, Stephen; Thapa, Pranita; Thapa, Surakschha; Joshi, Deepak; Dhungana, Adhish; KC, Anjana; Guenther, Tanya; Adhikari, Shilu; Scudder, Elaine; Ram, Pavani K.

doi:10.1186/s12913-020-05393-1

BMC Health Services Research

Table 5 Quality/ Appropriateness of Care for Sick Young Infants (unprompted questions)

From: A national survey of private-sector outpatient care of sick infants and young children in Nepal

	Medicine shops (%)				Physician-run Clinics (%)
Proximity to hospital (in minutes)	< 30 min	30–60 min	>60 min	All	Physician-run Clinics (%)
Sick young infants < 2 months of age	n = 200	n = 100	n = 100	n = 400	n = 82
Reports assessing for:
Respiratory rate	92	92	86	91	90
Temperature	91	80	90	88	89
Feeding (as reported by mother)	67	65	61	65	82†
Seizures (as reported by mother)	17	36	23	24	62†
Weight	28	44	29	32	66†
Chest in-drawing	48	59	57	53	60
Umbilical redness or pus	31	25	24	28	48††
Level of consciousness	14	21	23	18	46†
Treatment
*Usual first-lineoralantibiotic*	n = 200	n = 100	n = 100	n = 400	n = 82
Amoxicillin (+/− clavulanate)	63	76	77	73	82
Cefixime	41	30	28	35	39
Cefpodoxime	1	7	2	3	17
Cotrimoxazole	6	13	8	8	8
others	7	8	18	10	8
*Usual first-lineinjectableantibiotic*^a	n = 28	n = 17	n = 36	n = 81	N = 38
Gentamicin	51	34	63	53	21††
Ampicillin	16	9	16	14	37††
Cefotaxime	20	47	16	24	29
Ceftriaxone	20	17	22	20	24
Amikacin	9	20	0	7	16
others	0	0	3	1	11††
Other treatments used	n = 200	n = 100	n = 100	n = 400	N = 82
Bronchodilators	50	37	34	43	43
Injectable steroids	11	11	11	11	21
Steroids given within past 6 mo.	5	10	7	6	12
Dosage determination & weighing	n = 200	n = 100	n = 100	n = 400	N = 82
Determines dose by age, not weight	30	30	50	35	10†
Doses by weight, determined by^b:	n = 140	n = 68	n = 50	n = 258	N = 71
Salter or pan scale	9	9	12	10	63
Adult scale (subtract. technique)	82	81	68	79	37
Estimates by looking	9	10	20	11	0
Among those weighed,	n = 129	n = 61	n = 39	n = 229	N = 71
leaves baby’s clothes on	97	97	100	97	80††
Shortened treatment course	n = 200	n = 100	n = 100	n = 400	N = 82
Somewhat or very often	50	53	36	48	40
Danger sign referral	n = 200	n = 100	n = 100	n = 400	N = 82
Helps arrange transport	60	83	57	65	59
Provides referral note	42	65	58	52	77†
Calls ahead to MD at receiving HF	25	16	20	22	39††
Gives pre-referral oral antibiotics	42	60	59	51	48
Gives pre-referral inj. Antibiotics	5	8	13	8	12
Schedules follow-up visits	99	98	99	99	95

^a denominator includes only those reporting having used injectable antibiotics to treat sick infants over the previous 6 months
^b denominator includes only those reporting determining dose based on weight
† p-value on difference between medicine shops and clinics < 0.001
†† p-value on difference between medicine shops and clinics < 0.05

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ISSN: 1472-6963

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