Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

Abstract

Aim: The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses.Methods: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs' assessment and classification of sick children were followed by child re-examination by a trained health officer. Results:The classification by the HEWs of 620 sick children as compared to the reexaminer had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively.Conclusion: Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. 2100

Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey

“…Further, treatment with Ready-to-Use Therapeutic Food was not provided according to the measurements or classification. In the sub-study reporting disease classification also by re-examination of the same sick children as in this study, only 40% were correctly classified for malnutrition [17]. The physical danger signs, i.e., visible severe wasting and pitting edema, were also assessed in few children.…”

“…Interventions have been implemented to improve the quality of community case management programs, showing that performance reviews and clinical mentoring were successful [13], while supportive supervision had less evident effect on quality of services [10,13]. A recent study, based on the same larger survey as this article, showed that the health extension workers' diagnostic accuracy was low [17]. The utilization of child curative services at the health post has also remained on a relatively low level [7].…”

“…In another sub-study of our larger baseline survey, the sick children included in this study were re-examined by a clinical officer immediately after the observed examination and management session reported here. Only 60% of children with acute respiratory tract infection (suspected pneumonia) were correctly identified (sensitivity) by the health extension worker [17]. Antibiotic treatment was provided to a proportion of the children classified as suspected pneumonia and also to some children without any suspected pneumonia.…”

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia

“…This evaluation is linked to an ongoing process evaluation as well as in-depth substudies that address the Women’s Development Army leaders’ promotion of maternal and child health, quality of care provided by HEWs, equity and geographic distribution of service utilisation that can also offer further explanations to the observed lack of effect. 18 40 42 43 Given the overall low care-seeking for childhood illnesses in this study continued efforts are needed to strengthen the primary care services for under-five children.…”

“…The quality of iCCM services measured at baseline was low, and it is unlikely to have been improved by the training, supervision and infrequent clinical mentoring supported by OHEP. 18 …”