[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-113022-en":3,"doc-seo-113022-105":29,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":13,"seo_description":14,"update_tm":27,"read_time":28},113022,7971461741311,"Ophelia","https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826",8,"Research & Report","Quality of clinical assessment and child mortality - a three-country cross-sectional study","This analysis identifies gaps in the quality of health care in Central Africa and evaluates the relationship between clinical assessment quality and mortality among children aged 2–59 months. Regionally representative facility and household surveys from the Democratic Republic of the Congo, Cameroon, and the Central African Republic were collected from 2012 to 2016. Trained assessors observed sick-child visits to measure diagnostic and danger sign compliance. Using multi-level logistic regression on data covering 13,618 live births and 643 rated facilities, higher protocol compliance corresponded to markedly lower mortality odds.","Public Disclosure Authorized Public Disclosure Authorized  \nHealth Policy and Planning, 35, 2020, 878–887 doi: 10.1093/heapol/czaa048  \nAdvance Access Publication Date: 24 June 2020 Original Article  \nQuality of clinical assessment and child  \nmortality: a three-country cross-sectional study  \nNicole A. Perales  1, *, Dorothy Wei2, Aayush Khadka2,3,  \nHannah H. Leslie  2, Sa¨ıdou Hamadou4, Gervais Chamberlin Yama5, Paul Jacob Robyn4, Gil Shapira6, Margaret E. Kruk  2, and Gu¨nther Fink,7  \n1School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94720, USA, 2Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA, 3Graduate School of Arts and Sciences, Harvard University, 350 Massachusetts Avenue, Cambridge MA 02138, USA, 4 Health, Nutrition and Population Unit, The World Bank, 1818 H Street NW, Washington, DC 20433, USA, 5 Poverty and Equity Unit, The World Bank, 1818 H Street NW, Washington, DC 20433, USA, 6 Development Research Group, The World Bank, 1818 H Street NW, Washington, DC 20433, USA and 7Swiss Tropical and Public Health Institute and University of Basel, Socinstrasse 57, Basel 4051, Switzerland  \n*Corresponding author. University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA 94720, USA. E-mail: [nperales@berkeley.edu](nperales@berkeley.edu)  \nAccepted on 21 April 2020  \nAbstract  \nThis analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2–59months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016 . These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2–59months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2–59months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14 . 1%(adjusted odds ratio (aOR) 95% CI: 0 .025–0.244) reduction in the odds of mortality at age 2–59months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3%(aOR 95% CI: 0.058–0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2–59months could be possible if compliance were improved.  \nKeywords: Child health, quality of care  \nIntroduction  \nDespite annual mortality reductions of 4.1% over the past 15 years, sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world (UNICEF, 2015) . Sustainable  \nDevelopment Goal 3 aims to end preventable deaths of newbornsand children under age 5 by 2030, with all countries aiming to reduce under-5 mortality to at most 25 per 1000 live births (United Nations, 2015) . Major efforts will be necessary to reach this target  \nVC The Author(s) 2020 . Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.  \nFor permissions, please e-mail: [journals.permissions@oup.com](journals.permissions@oup.com) 878  \nDownloaded from [https://academic.oup.com/heapol/article/35/7/878/5861734 by Joint Bank-Fu","cbCaiqwTXE8vfJ0C","https://ap.wps.com/l/cbCaiqwTXE8vfJ0C","pdf",467191,1,10,"English","en",105,"# Abstract\n# Introduction\n## Key Messages\n# Table 1 Analytic samples","[{\"question\":\"Which countries and data sources were used in the three-country study?\",\"answer\":\"The study used regionally representative facility and household surveys from the Democratic Republic of the Congo, Cameroon, and the Central African Republic, collected between 2012 and 2016.\"},{\"question\":\"How was clinical assessment quality measured during sick-child visits?\",\"answer\":\"Trained assessors directly observed sick-child visits and evaluated compliance with diagnostic and danger sign protocols.\"},{\"question\":\"What was the association between protocol compliance and child mortality at ages 2–59 months?\",\"answer\":\"Greater compliance with diagnostic protocols and select general danger sign protocols was associated with reduced odds of mortality at ages 2–59 months.\"}]",1784499012,25,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":13,"keywords":33,"description":14,"schema_data":34,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":27},"quality-of-clinical-assessment-and-child-mortality-a-three-country-cross-sectional-study","",{"@graph":35,"@context":85},[36,53,68],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,50],{"item":40,"name":41,"@type":42,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/document/","Document",2,{"item":48,"name":12,"@type":42,"position":49},"https://docshare.wps.com/document/research-report/",3,{"item":51,"name":13,"@type":42,"position":52},"https://docshare.wps.com/document/quality-of-clinical-assessment-and-child-mortality-a-three-country-cross-sectional-study/113022/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":40,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-20","2026-07-19",true,{"@type":65,"interactionType":66,"userInteractionCount":20},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"Which countries and data sources were used in the three-country study?","Question",{"text":75,"@type":76},"The study used regionally representative facility and household surveys from the Democratic Republic of the Congo, Cameroon, and the Central African Republic, collected between 2012 and 2016.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"How was clinical assessment quality measured during sick-child visits?",{"text":80,"@type":76},"Trained assessors directly observed sick-child visits and evaluated compliance with diagnostic and danger sign protocols.",{"name":82,"@type":73,"acceptedAnswer":83},"What was the association between protocol compliance and child mortality at ages 2–59 months?",{"text":84,"@type":76},"Greater compliance with diagnostic protocols and select general danger sign protocols was associated with reduced odds of mortality at ages 2–59 months.","https://schema.org",{"og:url":51,"og:type":87,"og:title":13,"og:site_name":58,"og:description":14},"article",{"robots":89,"canonical":51},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":92},[93,97,101,105,110,115,120,123,128,131,134],{"id":20,"doc_module":4,"doc_module_name":45,"category_name":94,"show_sort_weight":95,"slug":96},"Story & Novel",90,"story-novel",{"id":46,"doc_module":4,"doc_module_name":45,"category_name":98,"show_sort_weight":99,"slug":100},"Literature",80,"literature",{"id":52,"doc_module":4,"doc_module_name":45,"category_name":102,"show_sort_weight":103,"slug":104},"Exam",70,"exam",{"id":106,"doc_module":4,"doc_module_name":45,"category_name":107,"show_sort_weight":108,"slug":109},5,"Comic",60,"comic",{"id":111,"doc_module":4,"doc_module_name":45,"category_name":112,"show_sort_weight":113,"slug":114},6,"Technology",50,"technology",{"id":116,"doc_module":4,"doc_module_name":45,"category_name":117,"show_sort_weight":118,"slug":119},7,"Healthcare",40,"healthcare",{"id":11,"doc_module":4,"doc_module_name":45,"category_name":12,"show_sort_weight":121,"slug":122},30,"research-report",{"id":124,"doc_module":4,"doc_module_name":45,"category_name":125,"show_sort_weight":126,"slug":127},9,"Religion & Spirituality",20,"religion-spirituality",{"id":126,"doc_module":4,"doc_module_name":45,"category_name":129,"show_sort_weight":126,"slug":130},"World Cup","world-cup",{"id":21,"doc_module":4,"doc_module_name":45,"category_name":132,"show_sort_weight":21,"slug":133},"Lifestyle","lifestyle",{"id":135,"doc_module":4,"doc_module_name":45,"category_name":136,"show_sort_weight":106,"slug":137},19,"General","general"]