Risk and protective factors for two types of error in the treatment of children with fever at outpatient health facilities in Benin

Abstract

Background. In developing countries, health workers often do not follow clinical practice guidelines. However, few studies have examined why different types of errors occur. Methods. We analysed a sample of consultations of children with non-severe malaria (defined as fever without signs of severe illness) from a health facility survey conducted in Ouémé Département, Benin. Treatment was defined as correct (recommended antimalarial), a minor error (non-recommended antimalarial), or a major error (no antimalarial). Results. In all, 85 health workers and 289 children were studied. In a multivariate logistic regression analysis, the following factors were significantly associated with major errors: treatment by a physician (adjusted odds ratio [aOR] = 13.57, 95% CI: 1.45-126.75), child's age < 12 months (aOR = 3.41, 95% CI: 1.15-10.07), and child's temperature (aOR = 0.58 per °C, 95% CI: 0.34-0.97). Factors significantly associated with minor errors were: child's temperature (aOR = 1.43 per °C, 95% CI: 1.07-1.92), electricity at the health facility (aOR = 3.10, 95% CI: 1.05-9.17), ≥ 1 supervision visit in the past 6 months (aOR = 0.33, 95% CI: 0.14-0.77), fever treatment wall chart in the consultation room (aOR = 0.29, 95% CI: 0.12-0.73), and number of non-fever chief complaints (aOR = 0.67 per complaint, 95% CI: 0.48-0.93). In-service training in malaria treatment was not significantly associated with either error type. Conclusions. Many factors may influence health worker performance, and factors such as pre-service training may influence performance in unexpected ways. Identifying different errors and analysing them separately can help reveal potential causes that may be masked by combining errors into a single category.