QUALITY ASSURANCE OF A DIARRHEA CONTROL PROGRAM IN NORTHEASTERN BRAZIL

In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern B razil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed i n the facilities were lack of information on target population and cov erage, lack of equipment to permit rehydration in the premises, and fr equent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling in formation given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration. but 90% were sent hom e immediately and not kept in the facilities to practice rehydration u nder guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The stud y showed that oral rehydration therapy is well established in the gove rnment health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case manage ment and health education.