TY - JOUR T1 - A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico. AU - Bojalil,R, AU - Guiscafré,H, AU - Espinosa,P, AU - Viniegra,L, AU - Martínez,H, AU - Palafox,M, AU - Gutiérrez,G, PY - 1999/12/29/pubmed PY - 1999/12/29/medline PY - 1999/12/29/entrez KW - Age Factors KW - Americas KW - Child KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diarrhea KW - Diseases KW - Education KW - Evaluation KW - Evaluation Report KW - Health KW - Health Personnel KW - Health Services KW - Infections KW - Latin America KW - Mexico KW - North America KW - Physicians KW - Population KW - Population Characteristics KW - Primary Health Care KW - Respiratory Infections KW - Training Programs KW - Treatment KW - Youth SP - 936 EP - 45 JF - Bulletin of the World Health Organization JO - Bull World Health Organ VL - 77 IS - 11 N2 - In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors. SN - 0042-9686 UR - https://www.unboundmedicine.com/medline/citation/10612890/A_clinical_training_unit_for_diarrhoea_and_acute_respiratory_infections:_an_intervention_for_primary_health_care_physicians_in_Mexico_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/10612890/ DB - PRIME DP - Unbound Medicine ER -