Comparison of Methods for Assessing Quality of Care for Community Case Management of Sick Children: An Application with Community Health Workers in Malawi

Cardemil, Cristina V.; Gilroy, Kate; Callaghan-Koru, Jennifer A.; Nsona, Humphreys; Bryce, Jennifer

doi:10.4269/ajtmh.2012.12-0389

Cited by 31 publications

(52 citation statements)

References 24 publications

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“…Despite these achievements, only about one-third of children with severe illness were correctly managed, which is consistent with prior research 17,36. An important reason for this result was that only about one-half of children needing referral to a health facility were referred by the HEW.…”

Section: Discussionsupporting

confidence: 86%

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

Miller¹,

Amouzou²,

Tafesse³

et al. 2014

The American Journal of Tropical Medicine and Hygiene

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150

181

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Ethiopia has scaled up integrated community case management of childhood illness (iCCM) in most regions. We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs). Data collectors observed HEWs' consultations with sick children and carried out gold standard re-examinations. Nearly all HEWs received training and supervision, and essential commodities were available. HEWs provided correct case management for 64% of children. The proportions of children correctly managed for pneumonia, diarrhea, and malnutrition were 72%, 79%, and 59%, respectively. Only 34% of children with severe illness were correctly managed. Health posts saw an average of 16 sick children in the previous 1 month. These results show that iCCM can be implemented at scale and that community-based HEWs can correctly manage multiple illnesses. However, to increase the chances of impact on child mortality, management of severe illness and use of iCCM services must be improved.

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Section: Discussionsupporting

confidence: 86%

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

Miller¹,

Amouzou²,

Tafesse³

et al. 2014

The American Journal of Tropical Medicine and Hygiene

Self Cite

150

181

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“…However, prior studies which have used direct observation to evaluate CHW performance have found evidence of the Hawthorne effect, where CHWs may have followed guidelines more accurately under observation in a clinical setting compared to their community environment [8, 32]. Register review has previously been found to approximate results from a medical professional directly observing CHW performance [31, 32], and can offer a number of advantages: we were able to screen and analyse approximately 22,000 records in less time, with fewer resources compared to a direct observation method, without having to remove CHWs or health centre workers from their normal work. Second, the analysis was limited to data that were routinely recorded, but other unrecorded factors could also have influenced a CHW’s decision to refer or not, including perceptions of the availability and quality of care available at local facilities, caregiver demands, and interpersonal relationships.…”

Section: Discussionmentioning

confidence: 99%

Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda

Lal

Ndyomugenyi

Paintain

et al. 2016

Malar J

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BackgroundMany malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence to the referral guideline.MethodsA secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs and symptoms. CHW treatment registers were reviewed to identify children eligible for referral according to training guidelines (temperature of ≥38.5 °C), to assess whether CHWs adhered to the guidelines and referred them. Factors associated with adherence were examined with logistic regression models.ResultsCHWs failed to refer 58.8% of children eligible in the moderate-to-high transmission and 31.2% of children in the low transmission setting. CHWs using RDTs adhered to the referral guidelines more frequently than CHWs not using RDTs (moderate-to-high transmission: 50.1 vs 18.0%, p = 0.003; low transmission: 88.5 vs 44.1%, p < 0.001). In both settings, fewer than 20% of eligible children received pre-referral treatment with rectal artesunate. Children who were prescribed ACT were very unlikely to be referred in both settings (97.7 and 73.3% were not referred in the moderate-to-high and low transmission settings, respectively). In the moderate-to-high transmission setting, day and season of visit were also associated with the likelihood of adherence to the referral guidelines, but not in the low transmission setting.ConclusionsCHW adherence to referral guidelines was poor in both transmission settings. However, training CHWs to use RDT improved correct referral of children with a high fever compared to a presumptive diagnosis using sign and symptoms. As many countries scale up CHW programmes, routine monitoring of reported data should be examined carefully to assess whether CHWs adhere to referral guidelines and take remedial actions where required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1609-7) contains supplementary material, which is available to authorized users.

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“…[17] The practical limitations of direct supervision of CHWs by formally trained health professionals were mitigated to different degrees, depending on the tasks being evaluated. There was little difference between supervision under direct observation, compared to supervision not under direct observation when the required protocols implemented by the CHWs were simple.…”

Section: Discussionmentioning

confidence: 99%

Training and Supervision of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC: Implications for Scaling Up

Abrahams‐Gessel¹,

Denman

Montano

et al. 2015

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Background Community health workers (CHWs) can screen for cardiovascular disease (CVD) risk as well as health professionals using a non-invasive screening tool (data unpublished). However, this demonstrated success does not guarantee effective scaling of the intervention to a population level. Objectives To report lessons learned from supervisors’ experiences monitoring CHWs and perceptions of other stakeholders regarding features for successful scaling of interventions which incorporate task-sharing with CHWs. Methods We conducted a qualitative analysis of in-depth interviews to explore stakeholder perceptions. Data was collected through interviews of 36 supervisors and administrators at non-governmental organizations contracted to deliver and manage primary care services using CHWs, directors and staff at the government health care clinics, and officials from the departments of health responsible for the implementation of health policy. Results CHWs are recognized for their value in offsetting severe human resource shortages and for their expert community knowledge. There is a lack of clear definitions for roles, expectations, and career paths for CHWs. Formal evaluation and supervisory systems are highly desirable but nonexistent or poorly implemented, creating a critical deficit for effective implementation of programs utilizing task sharing. There is acknowledgement of environmental challenges (e.g. safety) and systemic challenges (e.g. respect from trained health professionals) that hamper the effectiveness of CHWs. The government-community relationships presumed to form the basis of redesigned health care services have to be supported more explicitly and consistently on both sides in order to increase the acceptability of CHWs and their effectiveness. Conclusions The criteria critical for successful scaling of CHW led screening are consistent with evidence for scaling up communicable disease programs. Policy makers have to commit appropriate levels of resources and political will to ensure successful scaling of this intervention.

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Comparison of Methods for Assessing Quality of Care for Community Case Management of Sick Children: An Application with Community Health Workers in Malawi

Cited by 31 publications

References 24 publications

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda

Training and Supervision of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC: Implications for Scaling Up

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