Assessing Village Health Workers’ Ability to Perform and Interpret Rapid Diagnostic Tests for Malaria 4 Years after Initial Training: A Cross-Sectional Study

Abstract

Village health workers (VHWs) in Bugoye subcounty, Uganda, provide integrated community case management (iCCM) care to children younger than 5 years for malaria, pneumonia, and diarrhea. We assessed the longevity of VHWs' skills in performing and reading malaria rapid diagnostic tests (RDTs) 4 years after initial training, comparing VHWs who had completed initial iCCM training 1 year before the study with VHWs who had completed training 4 years before the study. Both groups received quarterly refresher trainings. Trained interviewers observed 36 VHWs reading six mock RDTs each and performing an RDT as part of a larger skills assessment exercise. VHWs read 97% of mock RDTs correctly; of the 36 VHWs, 86% read all six mock RDTs correctly. Most VHWs scored either 12/13 or 13/13 on the RDT checklist (39% and 36%, respectively), with 25% scoring 11/13 or lower. For reading mock RDTs, VHWs in the first group (initial training 4 years before study) read 97% of mock RDTs correctly, whereas those in the second group (initial training 1 year before study) read 96% of mock RDTs correctly; the first group had a mean of 5.83 RDTs read correctly, compared with 5.77 RDTs read correctly in the second group (P = 0.83). For performing an RDT, the first group completed a mean of 12.0 steps correctly, compared with a mean of 12.2 correct steps in the second group (P = 0.60). Overall, VHWs demonstrated proficiency in reading RDTs accurately and performing RDTs according to protocol at least 4 years after initial iCCM training.

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

“…iCCM is a component of a larger VHW strategy, wherein VHWs treat childhood killer diseases within 24 h of symptom onset in order to save lives [ 2 ]. Trained community health workers (VHWs) treat paediatric malaria, pneumonia, and diarrhoea under the iCCM approach, typically in a community setting as opposed to a medical facility [ 2 , 8 ]. Consequently, iCCM lowers out-of-pocket costs, improves access to care, and brings treatment closer to home [ 2 , 5 ].…”

“…Using a clinical algorithm, the VHWs diagnose and treat malaria, pneumonia, and diarrhoea. This involves giving any child who presents with a subjective fever a rapid diagnostic test (RDT) for malaria and interpreting the test's results [ 8 ]. By improving access to timely care, iCCM may be able to lower morbidity and death rates [ 9 ].…”

Point-of-care C-reactive protein measurement by community health workers safely reduces antimicrobial use among children with respiratory illness: results from a stepped wedge cluster-randomized trial in rural Uganda

“…(12)(13)(14) Evaluations of such programs have demonstrated that CHW are able to provide a high quality of care for malaria by utilizing malaria rapid diagnostic tests (mRDTs) for diagnosis. (15)(16)(17) The quality of pneumonia management is less consistent. (15,18) According to the iCCM algorithm, children who have both cough and fast breathing (i.e., tachypnea) are diagnosed with pneumonia and treated with antibiotics.…”

Design and Assessment of a Smartphone-based Educational Software for Malaria Detection

“…The results of many studies have shown that the use of mobile education helps in managing diseases such as AIDS, tuberculosis, diabetes and cerebral palsy [8][9][10][11]. In recent years, mobile technology has also been used to monitor malaria treatment [12][13]. The aims of this study were to design an educational software for malaria and evaluate the satisfaction level of the software application among students of Vector Biology and Disease Control in Kerman University of Medical Sciences.…”