Evaluation of the Guideline for Integrated Management of adult and Adolescent Illness on HIV Patients in Addis Ababa

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Addis Abeba Universty


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. vii 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.



Evaluation of the Guideline for Integrated Management