In many African countries, a nurse is the only health worker a patient
might ever see. But most nurses are not well trained at diagnosing
common diseases, and this can be a problem. However, as Rose Hoban
reports, some nurses in Kenya now have a new low-cost, low-tech tool
right at their fingertips to help them reach the right diagnosis.
health Professor Paula Tavrow from the University of California at Los
Angeles says nurses in African clinics often don't have the time or the
training to figure out what's wrong with patients who may be seriously
ill or have a hard-to-identify condition.
"Their inclination is to go
for a quick decision," Tavrow says. "Fever - it's malaria. Running nose
- pneumonia. I mean, just really quick decisions."
For example, in many
places, Tavrow says nurses were not recognizing the symptoms of HIV in
children. This meant the children didn't get into treatment - when it
was available - in time to make a difference.
So, Tavrow worked with
experts and local providers to create a simple notebook to help the
nurses make more sophisticated clinical decisions. The health care
provider goes through a list of preprinted questions with the mother,
asking about symptoms and checking off answers.
"So, they then ask them
some other questions. They assess whether the child has oral thrush and
so on, and if the child has several of these risk factors, then the
mother is encouraged to take the child for an HIV test," Tavrow
In the clinic where Tavrow tested the booklets, she says
nurses went from never encouraging mothers to bring their child for HIV
testing, to suggesting it 21 percent of the time. She also says nurses
went from never asking mothers about their HIV status to asking about
it 50 percent of the time.
Tavrow also developed a laminated chart to
keep on the examination table with lots of information that providers
"This is just a very simple thing. It just has all of the
treatments all together, laminated. Put it right in your desk, just
right in front of you, so that when you are writing your prescription,
it's right there," Tavrow says. "You're looking down, because
providers don't want to seem like 'I am not knowledgeable' in front of
a patient. So if it's right there, they look. They don't have to suffer
any sort of embarrassment."
Tavrow also says the laminated reference
saved nurses time. They didn't have to spend time looking for reference
materials or looking up treatments.
Tavrow says the nurses did a better
job identifying children and mothers with HIV when they used the
She also says the providers liked the new tools. They
reported that their work went faster. All of the nurses asked for more
products to help improve their diagnostic skills.
Tavrow says the best
thing of all is that these materials were low-cost. The booklets cost
less than 10 cents, and the treatment charts were about $2. She says
this approach to expanding the diagnostic skills of nurses can be
easily replicated across the continent.
She recently presented her
research last month at the annual meeting of the American Public Health