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Checklist Helps Nurses in Kenya Identify, Treat Children with HIV

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.

Public 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 explains.

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 need.

"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 diagnostic aids.

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 Association.