Training Community Health Workers to Manage Uncomplicated and Severe Malaria: Experience From 3 Rural Malaria-Endemic Areas in Sub-Saharan Africa

Abstract

Background. Use of community health workers (CHWs) to increase access to diagnosis and treatment of malaria is recommended by the World Health Organization. The present article reports on training and performance of CHWs in applying these recommendations.Methods. Two hundred seventy-nine CHWs were trained for 3–5 days in Burkina Faso, Nigeria, and Uganda, and 19 were certified to diagnose and treat only uncomplicated malaria and 235 to diagnose and treat both uncomplicated and severe malaria. Almost 1 year after training, 220 CHWs were assessed using standard checklists using facility staff responses as the reference standard.Results. Training models were slightly different in the 3 countries, but the same topics were covered. The main challenges noticed were the low level of education in rural areas and the involvement of health staff in the supervision process. Overall performance was 98% (with 99% in taking history, 95% in measuring temperature, 85% for measuring respiratory rates, 98% for diagnosis, 98% for classification, and 99% for prescribing treatment). Young, single, new CHWs performed better than their older, married, more experienced counterparts.Conclusions. Training CHWs for community-based diagnosis and treatment of uncomplicated and severe malaria is possible with basic and refresher training and close supervision of CHWs’ performance.Clinical Trials Registration. ISRCTRS13858170.

Longitudinal analysis of the capacities of community health workers mobilized for seasonal malaria chemoprevention in Burkina Faso

“…These results are nonetheless consistent with another study on community health workers' performance conducted in Burkina Faso, Nigeria, and Uganda, where 98% of the tasks were mastered by respondents [15]. They are also consistent with those of a recent observational study conducted in the same context with 14 CBDs, which concluded that they "deliver acceptable quality of care" [16].…”

“…Many studies have shown that the personal characteristics of community health workers can be associated with their performance [8,11,15,27], suggesting that the CBDs to be trained should be carefully selected [11,28]. However, recent reviews reveal that results, particularly with regard to performance compared by type and sex, are not always consistent [12], and that "studies of workers with lower baseline performance showed greater improvements in prescribing medications…, vaccinating children,… and counseling…" [29].…”

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study

“…Once CHWs were identified, training was carried out by health staff (Burkina Faso and Uganda) or the investigative team (Nigeria) in sessions that covered theory and practice [8]. Training included diagnosis and recognition of uncomplicated and severe illness with danger signs, counting respiratory rate, diagnosis using RDTs (preparing, reading, recording results), and treatment dosage by age.…”

“…Training was evaluated through pre- and post-tests [8]. A total of 31, 40, and 164 CHWs passed all certification exams in Burkina Faso, Nigeria, and Uganda, respectively, and were authorized to diagnose and treat uncomplicated and severe malaria, but in Burkina Faso 19 CHWs failed the severe malaria component necessary for use of rectal artesunate, and were only authorized to diagnose and use ACTs.…”

A multi-site community randomized trial of community health workers to provide counseling and support for patients newly entering HIV care in rural Ethiopia: study design and baseline implementation

“…In many areas, CHWs have a critical function in allowing health systems to deliver health care in a cost-effective manner [5]. Task-shifting of certain health care tasks to CHWs has been employed in a variety of health programs, such those for tuberculosis and malaria [6–8]. …”