EVALUATION OF THE USE OF CLINICAL ALGORIT HMS IN PRIMARY HEALTH-CARE CENTERS IN NORTH CAMEROON

In February 1993, four years after their introduction, an assessment w as made of the use of clinical flow charts (algorithms) by 16 nurses i n charge of primary medical health centers in North Cameroon (Diamare Division, Far North Province). A study of the knowledge, attitude and behaviour of the nurses shows the flow charts to be appreciated as a t ool for diagnostic aid and for professional training. 11 nurses report an initial systematic use of the flow charts. This associates with th e observation of good skills in using the charts, observed among 10 of the nurses, and also with treatment standardisation. Problems in read ing the flow charts correctly hinder their systematic use in diagnosti c decision making. A retrospective analysis of 800 treatment prescript ions noted in the consultation registers, shows an average rate of tre atment standardisation of 75 %, varying from 52 to 98 % among the diff erent health centers. Three quarters of non standardised treatment is ineffective or inefficient. Specific training in using the flow charts , given in the form of a 4 day seminar to 7 of the nurses concerned, s howed no better results, after 4 years, than those obtained during a p ractical training session of a global nature, taking place in a functi onal health centre. Basic professional training, as well as previous p rofessional experience influences the performances of the nurses. This study confirms the need to introduce rationalisation in the prescript ion of treatment, and shows the importance of verifying practical user skills at the end of specific training sessions. It would be advisabl e to include the principles of clinical algorithms in the teaching pro grams of medical schools.