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.

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2012-11-07
2017-09-22
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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]
  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]
  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]
  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]
  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]
  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]
  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]
  8. Campbell JP, Maxey VA, Watson WA, , 1995. Hawthorne effect: implications for prehospital research. Ann Emerg Med 26: 590594.[Crossref]
  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]
  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]
  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]
  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.
  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.
  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.
  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.
  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]
  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]
  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.
  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.
  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]
  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]
  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]
  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]
  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]
  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]
  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.
  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.
  28. WHO/UNICEF, 2011. Caring for the Sick Child in the Community. Geneva: World Health Organization.
  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.
  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]
  31. Landis JR, Koch GG, , 1977. The measurement of observer agreement for categorical data. Biometrics 33: 159174.[Crossref]
  32. Stata Corp LP, 2009. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.
  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]
  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.
  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.
  36. Commission on Information and Accountability for Women's and Children's Health, 2011. Keeping Promises, Measuring Results. Geneva: World Health Organization.
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  • Received : 20 Jun 2012
  • Accepted : 19 Aug 2012

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