[Baseline survey on health training in management of the sick child Togo September 20 - October 17 1997]

A baseline survey was conducted in health facilities in the third arrondissement of Lome and in the prefectures of Kloto and Vo to assess the quality efficacy accessibility and availability of services before implementation of the Integrated Management of Childhood Illness (IMCI) strategy. 87 consultations with sick children were observed 45 health facilities were evaluated and interviews were held with 85 mothers and 45 health workers. 54% of the children presented with more than one problem. 85% had fever 59% had cough and 17% had diarrhea. The quality of services was insufficient in all health districts. Only 2% of health agents asked about the four general signs of gravity; nutritional status was evaluated in 4 out of 49 cases when the child was weighed; and vaccination status was verified in only 13 of 87 cases. Management of fever acute respiratory infections and diarrhea was inadequate. Mothers knew two relevant warning signs in 38% of the cases; how to prepare oral rehydration solution in 23% of the cases; the number of vaccination visits needed during the first year in 29% of the cases; and the health workers prescription in 15% of the cases. 44% of the health workers were trained in malaria treatment but none were trained in treatment of diarrhea or respiratory infections nutrition or immunization. Supervision was considered inadequate and delays in resupply of medicines and vaccines were reported by 44% of workers. Rural facilities were particularly poorly supplied. Only 13% of the facilities had essential drugs needed as part of the IMCI strategy and 42% had vaccines. The cold chain quality was low.