Table 5 Citations by participants related to dimension 5
Dimension 5: Impact of REC on patient management | |
|---|---|
The health worker perspective: better management and treatment | |
“For the prescription you do not need to look for medicines, it’s enough to just put the signs that the child has and REC will tell you the medicine indicated for the child. The other benefit is that the dosage is also given. Often it is difficult to calculate weight-adjusted dosages and you don’t know how much to give. But with REC, everything is inside, you just have to apply it.” Birth attendant, female | “The management of children, if it is applied correctly, is really good, it helps a lot. It also prevents us from prescribing drugs irrationally. (…) Often you could prescribe multiple substances to a child when they don’t need them. For instance, in a child with a cold we do not need to prescribe anything. REC tells you to do simple things, and in fact when the mother does them, it works out well.” HO, male |
“The biggest advantage of REC, in my opinion, is that it helps us avoid a lot of deaths, especially in children. A second biggest advantage is that it prevents you hesitating over the treatment.” HO, male | |
Additional prescription | |
“When there is a history of fever, I add paracetamol. But if it is just a cough or cold, without fever or elevated respiratory rate, here we [can rather] explain to the mother how to make [supportive home remedies, such as] infusions of eucalyptus leaves or applying Shea butter in the nostrils of the child. We then tell them to come back in 2 days if the child is not better” RN, female | “For example, if a child comes in with a cough, and I see the child coughing really badly, but the respiratory rate is not elevated, personally, I add an antibiotic. Sometimes also if a child comes in with a fever of 39 °C or over and their RDT is negative (…) if the child has no other condition except for a cough, I add an antibiotic.” Birth attendant, female |
Confidence in malaria RDT | |
(Answering the question “do you trust the RDT result”) “Well… more or less… Often the child is really febrile, you perform the RDT and it is negative. The child has no other pathology that causes fever, they have no cough, no diarrhoea, no skin infection, they only have a fever. So we give a 2-day follow up appointment and tell the mother to bring the child back. We are obligated to see the child again, to re-evaluate if they have diarrhoea or cough that can cause fever, thus we only treat that” HO, female | |
Acceptance of home remedies and conservative treatments | |
“For a cough or cold, treatments are counselling [about home remedies/conservative treatments]. But yourself as a clinician in front of the patient, you feel the need to do something [else/more]. Because I have gained experience with such cases, (…) I feel the management [with home remedies] is not good, when you treat with antibiotics it works” HO, male | “You only have to explain to the mother, to lead her to understand that with cough or cold we do not need an antibiotic. The majority don’t argue, they tell you that you taught them something, like boiling eucalyptus leaves with some sugar” HO, female |
“In our context it is difficult, when you see a mother who comes with her child coughing or with a cold, but the treatment is to tell her to make an infusion of eucalyptus leaves. Because in the health facility, the mother expects to receive drugs or products from the health centre, so she will leave unhappy if she now has to go find leaves and boil them. Because you know, here, we also have traditional practitioners prescribing leaves. The mothers don’t come to us for leaves. Sometimes we are obligated to give something else” RN, male | |