TY - JOUR
T1 - Assessing the quality of sick child care provided by community health workers
AU - Miller, Nathan P.
AU - Amouzou, Agbessi
AU - Hazel, Elizabeth
AU - Degefie, Tedbabe
AU - Legesse, Hailemariam
AU - Tafesse, Mengistu
AU - Pearson, Luwei
AU - Black, Robert E.
AU - Bryce, Jennifer
N1 - Funding Information:
The authors thank the Oromia Regional Health Bureau and the Ethiopian Federal Ministry of Health for their strong support of this research. Thanks to ABH Services, PLC for implementation of the survey. We also thank the JSI Research and Training Institute, Inc./Last 10 Kilometers Project (JSI/L10K) and the Integrated Family Health Program (JSI/IFHP). This work was supported by The United Nations Children''s Fund (award 1000017212, http:// www.unicef.org) and the Government of Canada (award 7056791,http://www.international.gc.ca/ international/index.aspx?lang = eng). NPM received funding from the United States National Institutes of Health Training Grant for Maternal and Child Health (HD046405, http://www.nih.gov). Co-author Mengistu Tafesse is employed by ABH Services, PLC. ABH Services, PLC, provided support in the form of salaries for author MT and managed data collection. The specific role of this author is articulated in the ''author contributions'' section.
Publisher Copyright:
© 2015 Miller et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2015/11/9
Y1 - 2015/11/9
N2 - Background As community case management of childhood illness expands in low-income countries, there is a need to assess the quality of care provided by community health workers. This study had the following objectives: 1) examine methods of recruitment of sick children for assessment of quality of care, 2) assess the validity of register review (RR) and direct observation only (DO) compared to direct observation with re-examination (DO+RE), and 3) assess the effect of observation on community health worker performance. Methods We conducted a survey to assess the quality of care provided by Ethiopian Health Extension Workers (HEWs). The sample of children was obtained through spontaneous consultation, HEW mobilization, or recruitment by the survey team. We assessed patient characteristics by recruitment method. Estimates of indicators of quality of care obtained using RR and DO were compared to gold standard estimates obtained through DO+RE. Sensitivity, specificity, and the area under receiver operator characteristic curve (AUC) were calculated to assess the validity of RR and DO. To assess the Hawthorne effect, we compared estimates from RR for children who were observed by the survey team to estimates from RR for children who were not observed by the survey team. Results Participants included 137 HEWs and 257 sick children in 103 health posts, plus 544 children from patient registers. Children mobilized by HEWs had the highest proportion of severe illness (27%). Indicators of quality of care from RR and DO had high sensitivity for most indicators, but specificity was low. The AUC for different indicators from RR ranged from 0.47 to 0.76, with only one indicator above 0.75. The AUC of indicators from DO ranged from 0.54 to 1.0, with three indicators above 0.75. The differences between estimates of correct care for observed versus not observed children were small. Conclusions Mobilization by HEWs and recruitment by the survey teams were feasible, but potentially biased, methods of obtaining sick children. Register review and DO underestimated performance errors. Our data suggest that being observed had only a small positive effect on the performance of HEWs.
AB - Background As community case management of childhood illness expands in low-income countries, there is a need to assess the quality of care provided by community health workers. This study had the following objectives: 1) examine methods of recruitment of sick children for assessment of quality of care, 2) assess the validity of register review (RR) and direct observation only (DO) compared to direct observation with re-examination (DO+RE), and 3) assess the effect of observation on community health worker performance. Methods We conducted a survey to assess the quality of care provided by Ethiopian Health Extension Workers (HEWs). The sample of children was obtained through spontaneous consultation, HEW mobilization, or recruitment by the survey team. We assessed patient characteristics by recruitment method. Estimates of indicators of quality of care obtained using RR and DO were compared to gold standard estimates obtained through DO+RE. Sensitivity, specificity, and the area under receiver operator characteristic curve (AUC) were calculated to assess the validity of RR and DO. To assess the Hawthorne effect, we compared estimates from RR for children who were observed by the survey team to estimates from RR for children who were not observed by the survey team. Results Participants included 137 HEWs and 257 sick children in 103 health posts, plus 544 children from patient registers. Children mobilized by HEWs had the highest proportion of severe illness (27%). Indicators of quality of care from RR and DO had high sensitivity for most indicators, but specificity was low. The AUC for different indicators from RR ranged from 0.47 to 0.76, with only one indicator above 0.75. The AUC of indicators from DO ranged from 0.54 to 1.0, with three indicators above 0.75. The differences between estimates of correct care for observed versus not observed children were small. Conclusions Mobilization by HEWs and recruitment by the survey teams were feasible, but potentially biased, methods of obtaining sick children. Register review and DO underestimated performance errors. Our data suggest that being observed had only a small positive effect on the performance of HEWs.
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U2 - 10.1371/journal.pone.0142010
DO - 10.1371/journal.pone.0142010
M3 - Article
C2 - 26551035
AN - SCOPUS:84952673789
SN - 1932-6203
VL - 10
JO - PloS one
JF - PloS one
IS - 11
M1 - e0142010
ER -