As part of a community-based project to reduce high childhood mortality rates in Siaya District, Kenya, CARE Kenya has trained CHWs in the use of a simplified Integrated Management of Childhood Illness (IMCI) algorithm to manage illnesses that are major contributors to childhood mortality: malaria, pneumonia, diarrhea, and measles. Since 1997, the CICSS project has provided CHWs with ongoing supervision and 2 refresher trainings. Two previous evaluations of CHWs performed by the CARE-CDC Health Initiative (CCHI) have shown variability in clinical skill levels among CHWs. To improve CHW performance, it is important to understand what CHW characteristics, patient factors and program inputs are associated with correct case management. The third CHW evaluation (planned for February-March 2001) will study potential predictors, including the demographic characteristics of CHWs, their training history, clinical experience, frequency and type of supervision, and attitudes towards the IMCI algorithm, self-efficacy, outcome expectancy, and external barriers to successful performance. Attitudes will be measured via a pre-evaluation questionnaire. Other potential predictors will be measured by project records and self-reporting by CHWs. We will evaluate the association of potential predictors with CHW ability to perform assessments (history and physical exam tasks) completely and accurately and CHW adherence to the simplified IMCI algorithm in making classification and treatment decisions. These outcome variables will be measured by direct observation of sick child consultations, review of CHW clinical records, and re-examination of the sick child by a clinician with demonstrated expertise in the algorithm. Results are pending.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. List predictors of CHW performance in the management of childhood illness in the CICSS project. 2. Understand CHW attitudes towards the IMCI algorithm. 3. Discuss the impact of refresher training and of ongoing supervision on CHW performance in the management of childhood illness.
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.