TY - JOUR
T1 - Quality of sick child care delivered by Health Surveillance Assistants in Malawi
AU - Gilroy, Kate E.
AU - Callaghan-Koru, Jennifer A.
AU - Cardemil, Cristina V.
AU - Nsona, Humphreys
AU - Amouzou, Agbessi
AU - Mtimuni, Angella
AU - Daelmans, Bernadette
AU - Mgalula, Leslie
AU - Aboubaker, Samira
AU - Bonongwe, Enoch
AU - George, Asha
AU - Kachule, Timothy
AU - Kambale, Susan
AU - Katsande, Regis
AU - Nkhono, Edwin
AU - Temani, Newton
AU - Zamasiya, Texas
PY - 2013/9
Y1 - 2013/9
N2 - Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs) - a cadre of community-based health workers - as part of a national scale-up of community case management of childhood illness (CCM) in Malawi.Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted 'gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers.Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs.Conclusion Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
AB - Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs) - a cadre of community-based health workers - as part of a national scale-up of community case management of childhood illness (CCM) in Malawi.Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted 'gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers.Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs.Conclusion Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
KW - Child health
KW - Malawi
KW - community case management
KW - community health worker
KW - quality of care
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U2 - 10.1093/heapol/czs095
DO - 10.1093/heapol/czs095
M3 - Article
C2 - 23065598
AN - SCOPUS:84883480041
SN - 0268-1080
VL - 28
SP - 573
EP - 585
JO - Health policy and planning
JF - Health policy and planning
IS - 6
ER -