Table 1 Assessment criteria, based on existing literature [20,21,22,23,24, 39,40,41,42] and expert feedback
General | |
• Greeted patient/carer | |
• Solicits what the problem is and allows patient to fully elaborate presenting problem | |
• Exhibits well organised approach to information-gathering | |
• Gave due attention to patient/carer (looking and listening) | |
• Washed hands | |
• Number of minutes spent examining patient behind the screen | |
• Arranges appropriate follow-up | |
• Gives patient a clear explanation of the condition, the treatment, what to look out for. | |
Cough symptom | |
• Asked duration of cough | |
• Asked about difficulty in breathing | |
• Asked about wheezing | |
• Asked about presence of fever | |
• Asked about sputum production | |
• Asked about TB history and exposure | |
• Listened to lung | |
• Told to return quickly if: breathing becomes difficult, child unable to drink, child becomes more ill, child has convulsions | |
Fever symptom | |
• Asked about duration of fever | |
• Asked about localising symptoms suggesting site of infection if not obvious (headache, neck stiffness, skin, mouth and pharynx, lungs, urinary tract, gastrointestinal tract) | |
• Site of infection obvious (Yes/No) | |
• If yes, examined for localising symptoms if site not obvious (neck stiffness, skin, mouth&pharynx, lungs, urinary tract, GI tract) | |
• (If infant with high fever) gave paracetamol/aspirin in correct dosage | |
• Advised increased fluid intake | |
• Told to return in 3 days if fever persists | |
Diarrhoea symptom | |
• Asked duration of diarrhoea | |
• Asked about presence of blood or mucus in stools | |
• Asked about vomiting | |
• Asked about HIV status/CD4 count | |
Checked for dehydration: | |
• Checked abdomen | |
• Pinched skin examining for signs of severe dehydration | |
• (If infant) checked for sunken fontanel | |
• Treated dehydration appropriately | |
• Referred case if severe or blood in stool | |
• Kept child under observation if moderately dehydrated | |
• Advised increased fluid intake until diarrhoea stops | |
• Told how to prepare and administer oral rehydration solution | |
• Told to return in 3 days if child does not improve or quickly if danger signs of dehydration appear | |
Abdominal pain symptom | |
• Asked about duration and progression | |
• Asked about presence of fever | |
• Asked about weight loss and appetite change | |
• Asked about blood or mucus in stools | |
• If female, asked about last menstrual period; chance of pregnancy | |
• Examined abdomen for location and nature of pain, and distension | |
• (If acute abdominal pain) checked for rebound tenderness • Told to return if: pain worsens, unable to tolerate liquids without vomiting, fever present |