Improving the quality of anthropometric measures during medical consultations with children aged under five years old in Burkina Faso

Abstract Objective Millions of medical consultations are conducted each year in Burkina Faso using the Electronic Register of Consultations (REC). Based on the consultation data collected, we present a method to quantify the quality of individual and ensembles of consultations conducted by frontline healthcare workers (FHWs). Methods We focus on anthropometric measurements and vital signs (age, weight, height, mid-upper arm circumference and temperature) of children aged between two months and five years old. We compare individual and ensemble of consultations to a multivariate probability distribution defined by an external population-specific, gold standard consultation dataset. By comparing the distributions of consultations to the reference probability distribution, we define a score to rate the quality of measurements and data entry of each FHW. Findings The defined scores allow us to detect which measurements are most problematic. They also allow us to detect potential biases in the consultation and treatment of different patient groups. No systematic gender-bias was found among FHWs. Height measurements were the most challenging; consultations with the lowest scores were associated with underestimated heights in children. Among these consultations, height was found to be even more underestimated among boys than girls. Conclusion Our findings enable us to support capacity building of frontline healthcare workers. The REC can be enriched with real-time specific alert on errors, individual FHW can be proposed targeted trainings, and dynamic dashboards can support district managers to navigate the entire population of FHWs and understand which problems should be prioritised. Research in context Knowledge before this study The use of the Electronic Register of Consultations (REC) improved Frontline Healthcare Workers’ (FHWs) adherence to the Integrated Management of Childhood Illness (IMCI) guidelines at the primary care level in Burkina Faso. The improvement included a better identification of danger signs and an increase in the proportion of correctly classified children under five years old. A former study reported how FHWs perceived the use and impact of the REC in their daily practice. While a high degree of satisfaction was expressed, FHWs also proposed improvements. FHWs proposed to increase the frequency of supervision and evaluation visits, which usually take place every three months. Supervision from district teams and coaches was globally positively perceived by FHWs, as it allowed them to identify and address errors, and therefore helped them to learn and improve. FHWs also proposed receiving compensations or prizes for the best health centres according to the evaluations. Contribution of this study In this study, we proposed a method to assess the quality of consultations conducted by FHWs. We focused on anthropometric measurements and vital signs that are systematically measured by FHWs during consultations of children aged between two months and five years old. We showed how this method can feed a live alert system that invites FHWs to verify their input in-real time when potential errors in specific measurements or data entries are identified. We found that height (length) measurements of children were the most challenging, as height (length) was frequently underestimated. Finally, we presented a dynamic dashboard that informs health district managers on the quality of care across the country (using a medal reward system), so they can prioritize their interventions and provide FHWs with targeted support to improve their skills.