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 Root Cause Analysis in Percentage of Children given Chemoprophylaxis from the Total Eligible Children Identified

 

The low performance means the children less than 5 years of age who are eligible for chemoprophylaxis are not receiving it as desired.

The data is available in Ni-kshay; analyse it in terms of :

  • Who did not receive the chemoprophylaxis? (Person Analysis) - Are they contacts of cases notified from the public sector/ private sector, of a specific gender or population group?
  • Whether they belong to a specific geographic area? (Place Analysis) - Specific Peripheral Health Institute (PHI)/ TB Unit (TU)? Difficult to access area?
  • Is poor performance in a particular time period? (Time Analysis) - If yes, is it uniform for all cases throughout a specific time period?

 

Process involved in Tuberculosis Preventive Treatment (TPT) for children less than 5 years:

  1. Complete contact tracing of the index case 
  2. Rule out active TB
  3. Prepare the list of children less than 5 years eligible for treatment
  4. Initiate and complete TPT

 

Case to case audit of the eligible children who did not receive chemoprophylaxis to find the cause can be done.

Obtain more information from the parents, health care workers and source records.

Some of the causes are listed below.

  Possible Causes Suggested Solutions
Was the child initiated on treatment? If No

Patient-related causes:

  • Deficient information about the parents and lack of risk perception
  • Apprehension regarding the medications and side effects
  • Confidentiality issues
  • Moved out of the place/ migrant

 

Provider-related causes:

  • Deficient knowledge of the provider (public or private)
  • Shortage of Human Resource (HR)
  • Proper counselling and education of the parents/ primary caregivers and the head of the family regarding the need for chemoprophylaxis and gaining the confidence of the family
  • Training the primary caregiver regarding proper administration, common side effects 
  • Follow-up and proper transfer out to the concerned TU
  • Duplication to be avoided

 

 

  • Provider targeted Information, Education, Communication (IEC), capacity building through trainings so that they are aware of the updated guidelines
  • Steps to provide adequate HR/ train available HR
How is treatment adherence? 

Is non-adherence due to:

  • Non-palatability of the drugs for the child?
  • Adverse Drug Reaction (ADR)?
  • Inadequate knowledge of the parents, on what to do on missed doses?
  • Poor monitoring of the treatment adherence by the providers?
  • Discussing with the paediatrician and finding a suitable solution
  • Timely identification and management of ADR
  • Facilitating proper communication of the parents with the National TB Elimination Programme (NTEP) staff
  • Entrusting the responsibility to a particular staff and proper monitoring
Is it due to the non-availability of drugs?
  • Disruption in supply chain management
  •  Finding the cause and addressing it
Are there any issues in reporting?
  • Problems with data entry in Ni-kshay
  • Proper monitoring/ training of staff/ sorting out internet issues etc.

 

Note: This page describes only an approach for analysis of low performance and has not captured the entire list of problems or solutions. The root cause analysis may be modified according to the local context.

 

Resources

 

Assessment

Question Option1 Option 2 Option3 Option 4 Correct answer Explanation Page id  Pretest Post-test
Which of these is not a possible cause for poor performance in percentage chemoprophylaxis for eligible children? Parent apprehension Ignorance of the provider Child moving out of the area and lost-to-follow-up Regular follow-up  4 Regular follow-up cannot be the possible cause for poor performance in percentage chemoprophylaxis for eligible children.      

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