Predictors of correct treatment of children with fever seen at outpatient health facilities in the Central African Republic

To identify factors associated with improved performance of health care wor kers who treat ill children in developing countries, the authors analyzed a sample of consultations of children with malaria (defined as any fever) fr om a national health facility survey conducted in the Central African Repub lic from December 1995 to January 1996. Twenty-eight health care workers an d 204 children were studied. A univariate analysis revealed the following s ignificant predictors of correct treatment, as defined by the Central Afric an malaria control program: high fever (odds ratio (OR) = 3.25, 95% confide nce interval (CI): 1.47, 7.17); correct health care worker diagnosis (OR = 2.59, 95% Cl: 1.39, 4.85); and the caregiver's reporting the child's fever to the health care worker (OR = 2.18, 95% CI: 1.32, 3.62). There was an une xpected inverse association between the presence of a fever treatment chart and correct treatment (OR - 0.19, 95% CI: 0.04, 0.91). Correct treatment w as marginally associated with a longer consultation time (p value for trend = 0.058), Neither in-service training in the treatment of fever nor superv ision was significantly associated with correct treatment. For child health programs to improve, targeted studies are needed to understand which facto rs, alone or in combination, improve health care worker performance.