1921
Special Supplement on integrated Community Case Management
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Direct observation (DO) with re-examination (RE) by a skilled clinician is a rigorous method for assessing health worker performance, but is not always feasible. We assessed the performance of 131 community health workers in Malawi in community case management of sick children with cough and fast breathing, fever, and diarrhea. We compared estimates of correct treatment measured through DO with RE (n = 382 cases) to DO only (n = 382 cases), register review (n = 1,219 cases), and case scenarios (n = 917 cases). Estimates of correct treatment of uncomplicated fever and diarrhea measured through DO only, register review, and case scenarios were within 9 percentage points of DO with RE estimates, while estimates for uncomplicated cough and fast breathing, and severe illness were substantially higher than DO with RE (12–51 percentage points above the estimate). Those planning for community health worker assessments in community case management can use these results to make an informed choice of methods on the basis of their objectives and the local context.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2012.12-0389
2012-11-07
2018-12-13
Loading full text...

Full text loading...

/deliver/fulltext/14761645/87/5_Suppl/127.html?itemId=/content/journals/10.4269/ajtmh.2012.12-0389&mimeType=html&fmt=ahah

References

  1. Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z, , 2007. Achieving child survival goals: potential contribution of community health workers. Lancet 369: 21212131.[Crossref] [Google Scholar]
  2. Rowe AK, Savigny D, Lanata CF, Victoria CG, , 2005. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 366: 10261035.[Crossref] [Google Scholar]
  3. Hermida J, Nicholas DD, Blumenfeld SN, , 1999. Comparative validity of three methods for assessment of the quality of primary health care. Int J Qual Health Care 11: 429433.[Crossref] [Google Scholar]
  4. Bryce J, Toole MJ, Waldman RJ, Voigt A, , 1992. Assessing the quality of facility-based child survival services. Health Policy Plan 7: 155163.[Crossref] [Google Scholar]
  5. Franco LM, Franco C, Kumwenda N, Nkhoma W, , 2002. Methods for assessing quality of provider performance in developing countries. Int J Qual Health Care 14 (Supp 1): 1724.[Crossref] [Google Scholar]
  6. Hrisos S, Eccles MP, Francis JJ, Dickinson HO, Kaner EF, Beyer F, Johnston M, , 2009. Are there valid proxy measures of clinical behaviour? A systematic review. Implement Sci 4: 37.[Crossref] [Google Scholar]
  7. Rowe SY, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, Rochat R, Deming MS, , 2006. The influence of observation and setting on community health workers' practices. Int J Qual Health Care 18: 299305.[Crossref] [Google Scholar]
  8. Campbell JP, Maxey VA, Watson WA, , 1995. Hawthorne effect: implications for prehospital research. Ann Emerg Med 26: 590594.[Crossref] [Google Scholar]
  9. Leonard KL, Masatu MC, , 2005. The use of direct clinician observation and vignettes for health services quality in developing countries. Soc Sci Med 61: 19441951.[Crossref] [Google Scholar]
  10. Rowe AK, Lama M, Onikpo F, Deming MS, , 2002. Health worker perceptions of how being observed influences their practices during consultations with ill children. Trop Doct 22: 166167.[Crossref] [Google Scholar]
  11. Rowe AK, Onikpo F, Lama M, Deming MS, , 2012. Evaluating health worker performance in Benin using the simulated client method with real children. Implement Sci 7: 95 (Published online 8 Oct 2012). doi: 10.1186/1748-5908-7-95.[Crossref] [Google Scholar]
  12. World Health Organization, 2007. Community Health Workers: What Do We Know about Them? The State of the Evidence on Programmes, Activities, Costs and Impact on Health Outcomes of Using Community Health Workers. Available at: http://www.who.int/healthsystems/round9_7.pdf. Accessed June 10, 2012. [Google Scholar]
  13. Ashwell HES, Freeman P, , 1995. The clinical competency of community health workers in the Eastern Highlands Province of Papua New Guinea. P N G Med J 38: 198207. [Google Scholar]
  14. Mehnaz A, Billoo AG, Yasmeen T, Nankani K, , 1997. Detection and management of pneumonia by community health workers: a community intervention study in Rehri Village, Pakistan. J Pak Med Assoc 47: 4245. [Google Scholar]
  15. Hadi A, , 2003. Management of acute respiratory infections by community health volunteers: experience of Bangladesh Rural Advancement Committee (BRAC). Bull World Health Organ 81: 183189. [Google Scholar]
  16. Baqui AH, Arifeen SE, Rosen HE, Mannan I, Rahman SM, Al-Mahmud AB, Hossain D, Das MK, Begum N, Ahmed S, Santosham M, Black RE, Darmstadt GL, Projahnmo Study Group, , 2009. Community-based validation of assessment of newborn illnesses by trained community health workers in Sylhet district of Bangladesh. Trop Med Int Health 14: 14481456.[Crossref] [Google Scholar]
  17. Darmstadt GL, Baqui AH, Choi Y, Bari S, Rahman SM, Mannan I, Ahmed ASM, Sahar SK, Rahman R, Chang S, Winch PJ, Black RE, Santosham M, El Arifeen S, for the Bangladesh Projahnmo-2 (Mirzapur) Study Group, , 2009. Validation of community health workers' assessment of neonatal illness in rural Bangladesh. Bull World Health Organ 87: 1219.[Crossref] [Google Scholar]
  18. Puett C, Coates J, Alderman H, Sadler K, , 2012. Quality of care for severe acute malnutrition delivered by community health workers in southern Bangladesh. Matern Child Nutr (Published online 19 Apr 2012). doi: 10.1111/j.1740-8709.2012.00409.x. [Google Scholar]
  19. Zeitz PS, Harrison LH, Lopez M, Cornale G, , 1993. Community health worker competency in managing acute respiratory infections of childhood in Bolivia. Bull Pan Am Health Organ 27: 109119. [Google Scholar]
  20. Kelly JM, Osamba B, Garg RM, Hamel MJ, Lewis JJ, Rowe SY, Rowe AK, Deming MS, , 2001. Community health worker performance in the management of multiple childhood illnesses: Siaya District, Kenya, 1997–2001. Am J Public Health 91: 16171624.[Crossref] [Google Scholar]
  21. Rowe SY, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, Rochat R, Deming MS, , 2007. Longitudinal analysis of community health workers' adherence to treatment guidelines, Siaya, Kenya, 1997–2002. Trop Med Int Health 12: 651663.[Crossref] [Google Scholar]
  22. Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE, Jr McFarland DA, Rochat R, Deming MS, , 2007. Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya, Kenya. Trans R Soc Trop Med Hyg 101: 188202.[Crossref] [Google Scholar]
  23. Kallander K, Tomson G, Nsabagasani X, Sabiiti JN, Pariyo G, Peterson S, , 2006. Can community health workers and caretakers recognise pneumonia in children? Experiences from western Uganda. Trans R Soc Trop Med Hyg 100: 956963.[Crossref] [Google Scholar]
  24. Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, Nsubuga P, Kallander K, , 2011. Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda. Trop Med Int Health 16: 12341242.[Crossref] [Google Scholar]
  25. Yasuoka J, Poudel KC, Poudel-Tandukar K, Nguon C, Ly P, Socheat D, Jimba M, , 2010. Assessing the quality of service of village malaria workers to strengthen community-based malaria control in Cambodia. Malar J 9: 109.[Crossref] [Google Scholar]
  26. Gilroy KE, Callaghan-Koru JA, Cardemil CV, Nsona H, Amouzou A, Mtimuni A, Daelmans B, Mgalula L, and Bryce J on behalf of the CCM-Malawi Quality of Care Working Group, , 2012. Quality of sick child care delivered by Health Surveillance Assistants in Malawi. Health Policy Plan: first published online October 13, 2012. doi:10.1093/heapol/czs095. [Google Scholar]
  27. World Health Organization, 2003. Health Facility Survey: Tool to Evaluate the Quality of Care Delivered to Sick Children Attending Outpatient Facilities. Available at: http://www.who.int/maternal_child_adolescent/documents/9241545860/en/index.html. Accessed June 10, 2012. [Google Scholar]
  28. WHO/UNICEF, 2011. Caring for the Sick Child in the Community. Geneva: World Health Organization. [Google Scholar]
  29. Institute for International Programs, Johns Hopkins Bloomberg School of Public Health. Quality of Care Tools (Malawi). Available at: www.jhsph.edu/dept/ih/IIP/projects/catalyticinitiative.html. [Google Scholar]
  30. Nsona H, Mtimuni A, Daelmans B, Callaghan-Koru JA, Gilroy K, Mgalula L, Kachule T, Zamasiya T, , 2012. Scaling-up integrated community case management of childhood illness: update from Malawi. Am J Trop Med Hyg 87 (Suppl 5): 5460.[Crossref] [Google Scholar]
  31. Landis JR, Koch GG, , 1977. The measurement of observer agreement for categorical data. Biometrics 33: 159174.[Crossref] [Google Scholar]
  32. Stata Corp LP, 2009. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP. [Google Scholar]
  33. Macfarlane J, Holmes W, Macfarlane R, Britten N, , 1997. Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ 315: 12111214.[Crossref] [Google Scholar]
  34. Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, Jaen CR, Crabtree BF, , 2001. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract 50: 853858. [Google Scholar]
  35. Gilroy K, Winch P, , 2006. Management of Sick Children by Community Health Workers: Intervention Models and Program Examples. UNICEF and WHO. Available at: www.coregroup.org/storage/Program_Learning/Community_Health_Workers/Management_of_Sick_Children_by_Community_Health_Workers.pdf. Accessed April 25, 2012. [Google Scholar]
  36. Commission on Information and Accountability for Women's and Children's Health, 2011. Keeping Promises, Measuring Results. Geneva: World Health Organization. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2012.12-0389
Loading
/content/journals/10.4269/ajtmh.2012.12-0389
Loading

Data & Media loading...

  • Received : 20 Jun 2012
  • Accepted : 19 Aug 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error