Does training affect quality of diarrhoea case management.

Improvement in diarrhoea case management through training of health care providers in the government and the private sector was the key element of diarrhoea policy in Pakistan in 1989. Numerous training sessions were organized by the Child Survival project. The aim of this project was to look at the effect of training on quality of diarrhoea case management at the oral rehydration therapy (ORT) corners and diarrhoea treatment units (DTUs) of Sindh. A systematic random sample of 62 ORT corners and DTUs in Sindh was assessed using the WHO drafted Health Facility Survey manual. It was observed that the trained health providers were better in taking history for blood in stools (P < 0.004) and other illnesses (p < 0.000). For assessment of dehydration, no significant difference (p < 0.933), was found between trained and untrained health providers. Trained were better than untrained (p < 0.035) only in treatment "Plan A" and correct rehydration (p < 0.004) of child at facility. Training did not influence advising mothers for home case management. Thus diagnosis was good and training did improve the quality of assessment of child but treatment (inclusive of advice giving) was not significantly affected by training, except for a child with no dehydration. It is recommended that on the job training should emphasize on skills for management of diarrhoea. Further studies are needed to identify why inspite of training. Health providers do not offer better treatment than the untrained ones.