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|Title: ||EVALUATION OF THE GUIDELINE FOR INTEGRATED MANAGEMENT OF ADULT AND ADOLESCENT ILLNESS ON HIV PATIENTS IN ADDIS ABABA|
|Authors: ||Martha, Wolde|
|Advisors: ||Fikre Enqueselassie (BSc, MSc, PhD)|
|Copyright: ||2007 |
|Date Added: ||21-Apr-2008 |
|Publisher: ||Addis Ababa University|
Back ground:-Acute Care module is one of Integrated Management of Adult and
Adolescent illnesses( IMAI) modules relevant for HIV care which are interim guidelines
released for country adaptation and use to help with the emergency scale-up of antiretroviral
therapy (ART) in resource-limited settings.
The module covers disease classifications and treatments for the care of acute illness such as
pneumonia, diarrhea, fever and sexually transmitted infections in adolescents and adults.
Ethiopia is one of the first countries to adapt and apply the guide lines, however, no study to
assess the validity of the guide line in identifying the problem of patients and in leading to
appropriate management decision is performed.
Objective: - To assess The performance of Acute Care guideline for IMAI against the
etiologic and / or clinical approach.
Methods:- The study applied a health center based Cross-sectional study design where by
patients seen by nurses who use acute care guideline in one room will be seen by physicians
using the etiologic and\or clinical approach in another room.
Results: - A total of 648 clients who were eligible for enrolments during the study period were included in
the study .63.3% of the clients were females and most 39.5 % were aged 25-34 years. In the study the
sensitivities of the guideline for URTI, pneumonia and tuberculosis were found to be 100%, 100%, and 87.5%
respectively. The specificity of the guideline for the mentioned disorders was 92.1%, 96.6% and 100%
respectively. The positive predictive value was 94.3%, 94.5%, and 100%.And the respective NPV was 100%,
100%, and 99.4%.However, specificity for severity of pneumonia was only 40.4%.
Accordingly in patients with diarrhea the sensitivity, specificity, PPV and NPV of the guideline for dysentery were
92.5%, 100%, 100%, and 96.6% respectively.
The sensitivities were 78.3% and 75.8%, specificities were 83.6% and 42.9%, and positive predictive values were
60.0% and 41.0% for the diagnosis of sever and some dehydration, respectively.Using the guideline sixty percent of the patients with acute pneumonia were treated with oral anti biotic and IM
antibiotics were given to 29.3% of them. However the physicians decided to treat 3 patients identified as sever
pneumonia cases using the guideline with IM antibiotics and only 26.7 of acute pneumonia cases were treated
with IM antibiotics.
Most patients diagnosed as dysentery were treated with oral antibiotics both by the physicians and the health
workers using the guideline, though 5.4% of them were sent to home only with ORS and advise on additional fluid
intake by the group using the guideline.
Conclusion & Recommendation:-The findings of the study suggested that syndromic
management of the mentioned diseases at the health center level is possible. However, the performance of the
guideline was very poor regarding level of severity in pneumonia, anemia and dehydration. Therefore the tested
guideline needs further modifications with emphasis on its ability in delineating the level of severity.|
|Description: ||A Thesis Submitted To Faculty of Medicine, School Of Graduate
Studies Of Addis Ababa University In Partial Fulfillment Of The
Requirement For The Degree Of Masters Of Public Health|
|Appears in:||Thesis - Public Health|
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