DIAGNOSTIC QUALITY IN RURAL HEALTH CENTERS IN BURKINA-FASO

OBJECTIVE To study the quality of diagnostic practice in rural Burkina Faso. METHOD In 9 health centres of 3 districts, 313 outpatient consu ltations were observed, and 417 diagnoses by 15 nurses were analysed. Criteria for evaluation of patient history and clinical examination we re based on the diagnostic guidelines distributed by the Ministry of H ealth. RESULTS In only 20% of the diagnoses the nurses took a sufficie nt history and in only 40% they conducted a sufficient clinical examin ation. In 21% patients underwent no clinical examination at all. Only 12% of all diagnoses were based on sufficient history-taking and adequ ate clinical examinations. The individual elements of clinical examina tion were performed correctly in 82% of cases. The Variation between n urses was immense, but no correlation could be found with regard to th eir basic training. However, nurses who had received the diagnostic gu idelines examined patients more carefully than those who had not. Larg er numbers of patients per day are not associated with shorter nurse-p atient contact, and neither is sufficiency of patient history associat ed with duration of the consultation. CONCLUSION The low diagnostic qu ality of the outpatient consultations in the studied area indicates th at this issue has been neglected in national public health initiatives . But examination skills are good and diagnostic guidelines may have h ad a positive effect on the diagnostic quality.