Child Health Services Tanzania Service Provision Assessment (TSPA)

Transcription

1 Child Health Services Tanzania Service Provision Assessment (TSPA)

2 Background of Child Health (2010 TDHS) Availability of Services Service Readiness Management Practices and Training Observations of Sick Child Consultations 2013 Jennifer Applegate, Courtesy of Photoshare

3 Basic Vaccinations Children who have received: BCG Measles 3 doses of DPT/pentavalent 3 doses of Polio (excluding polio 0) Are said to have received all basic vaccinations

4 Childhood Immunisations (2010 TDHS) Percent of children months immunised BCG Measles All basic None DPT-HB-Hib Polio 2

5 Trends in Immunisation Coverage Percent of children months fully immunised TDHS TDHS 1996 TRCHS 1999 TDHS TDHS 2010

6 Nutritional Status of Children (TDHS 2010) Percent of children under 5 Stunted (too short for age) Wasted (too thin for height) Moderate Severe Underweight (too thin for age) *Based on the new WHO Child Growth Standards

7 Childhood Mortality Levels (2010 TDHS) Deaths per 1,000 live births for the 5-year period before the survey Neonatal Mortality Postneonatal Mortality Infant Mortality Child Mortality Under-5 Mortality

8 Background of Child Health Availability of Services Service Readiness Management Practices and Training Observations of Sick Child Consultations 2013 Jennifer Applegate, Courtesy of Photoshare

9 Availability of Child Health Services Percent of all facilities (N=1,188) offering: Outpatient curative care for sick children Growth monitoring Child vaccination All 3 basic child health services

10 Availability of Child Health Services by Facility Type Percent of all facilities (N=1,188) offering: Hospital Health centre Dispensary Clinic Outpatient curative care for sick children Growth monitoring Child vaccination All 3 basic child health services

11 Availability of Child Health Services by Managing Authority Percent of all facilities (N=1,188) offering: Government Private-for-profit Parastatal Faith-based Outpatient curative care for sick children Growth monitoring Child vaccination All 3 basic child health services

12 Frequency of Child Health Services Among facilities offering outpatient curative care for sick children or growth monitoring, percent providing services for the indicated number of days per week Outpatient curative care for sick children (N=1,160) 19 Growth monitoring (N=997)

13 Frequency of Vaccination Services Among facilities offering various routine child vaccination services, percent providing each vaccination at the facility for the indicated number of days per week Routine polio (N=971) Pentavalent (N=971) Routine measles (N=968) Routine BCG (N=961) Pneumococcal (N=968) Rotavirus (N=970)

14 Background of Child Health Availability of Services Service Readiness Management Practices and Training Observations of Sick Child Consultations 2013 Jennifer Applegate, Courtesy of Photoshare

15 Guidelines and Equipment for Child Curative Services Percent of facilities offering curative care for sick children (N=1,160) Guidelines on IMCI 56 Guidelines on growth monitoring 24 Stethoscope 94 Timer 79 Thermometer 85 Child scale 83 Infant scale 52 Growth chart 57

16 Infection Control for Child Curative Services Percentage of facilities offering curative care for sick children (N=1,160) with: Soap & running water or else alcoholbased hand disinfectant 65 Latex gloves 80 Sharps container 85 Waste receptacle 56

17 Laboratory Diagnostic Capacity Percent of facilities offering outpatient curative services for sick children (N=1,160) that have the capacity to conduct the indicated tests in the facility Hospital Health centre Dispensary Clinic Total Haemoglobin Malaria Stool microscopy

18 Availability of Essential Medicines Percent of facilities offering outpatient curative care services for sick children (N=1,160) that have: ORS 86 Amoxicillin 65 Cotrimoxazole 73 Paracetamol 69 Vitamin A 67 Mebendazole/albendazole 90 Zinc tablets 44 ACT 90

19 Availability of Priority Medicines Percent of facilities offering outpatient curative care services for sick children (N=1,160) that have: Ampicillin powder for injection 17 Ceftriaxone powder for injection 58 Gentamycin injection 37 Benzathine penicillin for injection 75

20 Guidelines and Equipment for Vaccination Services Percent of facilities offering child vaccination services (N=968) Guidelines on EPI 84 Vaccine refrigerator 64 Vaccine carrier with ice pack 94 Sharps container 95 Syringes and needles 89

21 Infection Control for Vaccination Services Percent of facilities offering child vaccination services (N=968) with: Soap & running water or else alcoholbased hand disinfectant 58 Latex gloves 71 Sharps container 95 Waste receptacle 52

22 Availability of Vaccines by Facility Type Percent of facilities offering child vaccination services and storing vaccines (N=881) with all basic child vaccines DPT/pentavalent, oral polio, measles, BCG, pneumococcal, and rotavirus Hospital Health centre Dispensary Clinic Total

23 Availability of Vaccines by Managing Authority Percent of facilities offering child vaccination services and storing vaccines (N=881) with all basic child vaccines DPT/pentavalent, oral polio, measles, BCG, pneumococcal, and rotavirus Government Private-for-profit Parastatal Faith-based Total

24 Background of Child Health Availability of Services Service Readiness Management Practices and Training Observations of Sick Child Consultations 2013 Jennifer Applegate, Courtesy of Photoshare

25 Training and Supervision Child Health Service Providers Percent of interviewed child health providers (N=5,551) who reported receiving: In-service training related to child health during past 24 months Personal supervision during past 6 months Hospital Health centre Dispensary Clinic Total

26 Training of Child Health Service Providers Percent of interviewed child health providers (N=5,551) who reported receiving: During past 24 months At any time EPI/cold chain 8 19 IMCI 8 23 Malaria diagnosis Malaria treatment Acute respiratory infection 5 16 Diarrhoea diagnosis or treatment 7 21

27 Background of Child Health Availability of Services Service Readiness Management Practices and Training Observations of Sick Child Consultations 2013 Jennifer Applegate, Courtesy of Photoshare

28 Assessment of General Danger Signs during Observed Sick Child Consultations Percent of observed consultations (N=4,961) that assessed: Inability to eat or drink anything 28 Vomiting everything 49 Convulsions 20 All general danger signs 8

29 Assessment of Main Symptoms during Observed Sick Child Consultations Percent of observed consultations (N=4,961) that assessed: Cough or difficulty breathing 75 Diarrhoea 59 Fever 93 All 3 main symptoms 46 Ear pain or discharge 16 All 3 main symptoms plus ear pain/discharge 12

30 Physical Examination during Observed Sick Child Consultations Percent of observed consultations (N=4,961) that assessed: Temperature 68 Respiratory rate 13 Dehydration 15 Anaemia 42 Ear 15 Edema 6 Referred for any laboratory test 1

31 Essential Advice to Caretakers Percent of observed consultations (N=4,961) Give extra fluids to child 12 Continue feeding child 13 Symptoms requiring immediate return 17

32 Treatment of Children with Fever or Malaria Percent of observed children who received specific treatment, among those with indicated diagnosis Referred/admitted Given any antibiotic Given any antimalarial Fever (N=332) Malaria (N=1,641)

33 Treatment of Children with Respiratory Illness Percent of observed children who received specific treatment, among those with indicated diagnosis Referred/admitted Given any antibiotic Respiratory rate Pneumonia/bronchopneumonia (N=575) Cough or other upper respiratory illness (N=1,589)

34 Key Findings Outpatient curative care for sick children is one of the most widely available of all health services in Tanzania provided by 98% of facilities. 73% of facilities offering vaccination services and storing vaccines had all basic child vaccines at time of survey. All three general danger signs were assessed in only 8% of observed consultations of sick children. All three main symptoms were assessed in 46% of observed consultations of sick children. 26% of children with fever were treated with an antimalarial. 85% of children with cough or other respiratory illness were given an antibiotic.