Audit of outpatient department management of patients with respiratory symptoms in Lilongwe

Abstract

Setting: 6 outpatient departments (OPD) of 3 hospitals and 2 health centres in Lilongwe.

Objective: To assess the existing health worker practice in providing care to patients with respiratory symptoms in the OPD.

Methods:Between 1 and 31 July 2002 exit interviews were conducted with patients from OPD consultation rooms and possessing a prescription for respiratory diseases. Verbal confirmation of the patients\' complaints was done, patients\' OPD notes were reviewed and a questionnaire was completed. Data was collected for patients aged 5 and above.

Results: 3001 patients with median age of 27 years were enrolled in the study. 1203 (40%) were male. 80% had made several visits to the OPD with the same symptom. In some cases verbal reports of main symptoms did not match with those recorded on OPD notes. 511 (17%) patients reported that a clinician listened to their chest. Antibiotics were prescribed to 2501 (83.3%) patients for various respiratory complaints. Similarly analgesics were prescribed to 2671 (89%) patients. Steroids were prescribed to 32 (1.2%) patients and a bronchodilator was prescribed to 185 (6.2%) patients. Only 56 (2%) patients were referred to another level of care.

Conclusion: Management of patients with respiratory symptoms in Lilongwe is characterised by increased usage of antibiotics, analgesics and inability of health workers to examine the patients\' chests. Referral to other care facilities is also uncommon. More investigations are required to understand the causes of this practice so that corrective measures are designed and implemented.


Malawi Medical Journal Vol. 17(2) 2005: 36-38