Diagnostic quality in rural health centres in Burkina Faso

To create a consensus on rational diagnosis and treatment for the most frequent health problems encountered at the first level of care Burkina Fasos Ministry of Health has established guidelines for nurses in the field and flow charts indicating the questions and clinical examinations necessary for a given complaint. The effect of these guidelines on diagnostic quality was investigated in a field study of all 313 outpatient consultations and 417 diagnoses by 15 nurses in a 2-week period in 1995 in 9 rural health centers in Burkina Fasos Tougan Nouna and Solenzo Districts. The history taking fulfilled the predefined standards for 20% of the nurses diagnoses. In the remaining 80% at least one crucial item of information was not obtained. 40% of the diagnoses were based on sufficient clinical examination. No examination was conducted in 21% while the examination lacked an essential part in another 39%. Overall only 12% of diagnoses reviewed were based on adequate histories and physical examination. Diagnostic procedures were insufficient most often for diarrhea and most often adequate for malaria and respiratory tract illnesses. Although no correlation was found between adequate diagnostic quality and the nurses basic training those who had received the diagnostic guidelines examined patients more carefully than those who had not. Proposed to raise the quality of care in rural health centers are quality assurance measures such as supervision schemes that include assessment of diagnostic quality revisions in the national training curricula for nurses and steps to make the guidelines more accessible at the district level.