[Evaluation of the use of diagnostic/treatment algorithms in the health centers of North Cameroon].

In February 1993, four years after their introduction, an assessment was made of the use of clinical flow charts (algorithms) by 16 nurses in charge of primary medical health centers in Northern Cameroon (Diamare Division, Far North Province). A study of the knowledge, attitude and behaviour of the nurses shows the flow charts to be appreciated as a tool for diagnostic aid and for professional training. 11 nurses report an initial systematic use of the flow charts. This associates with the observation of good skills in using the charts, observed among 10 of the nurses, and also with treatment standardisation. Problems in reading the flow charts correctly hinder their systematic use in diagnostic decision making. A retrospective analysis of 800 treatment prescriptions noted in the consultation registers, shows an average rate of treatment standardisation of 75%, varying from 52 to 98% among the different health centers. Three quarters of non standardised treatment is ineffective or inefficient. Specific training is using the flow charts, given in the form of a 4 day seminar to 7 of the nurses concerned, showed no better results, after 4 years, than those obtained during a practical training session of a global nature, taking place in a functional health centre. Basic professional training, as well as previous professional experience influences the performances of the nurses. This study confirms the need to introduce rationalisation in the prescription of treatment, and shows the importance of verifying practical user skills at the end of specific training sessions. It would be advisable to include the principles of clinical algorithms in the teaching programs of medical schools.