Case management by community health workers of children with acute respiratory infections: implications for national ARI control programme
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Health worker performance in managing acute respiratory infections (ARI) in Nigerian children revealed significant gaps in history taking, examination, and communication. Improvements require enhanced training, supervision, and resource availability for better child healthcare.
Area of Science:
- Public Health
- Pediatrics
- Health Services Research
Background:
- Acute Respiratory Infections (ARI) are a leading cause of child mortality globally.
- Effective health worker performance is crucial for timely and accurate ARI management.
- Assessing current practices identifies areas for intervention in resource-limited settings.
Purpose of the Study:
- To evaluate health worker performance in managing pediatric ARI in Nigerian health facilities.
- To identify specific training needs and performance gaps.
- To inform strategies for improving ARI case management quality.
Main Methods:
- Cross-sectional survey in two Nigerian Local Government Areas (LGAs).
- Utilized observation checklists, health worker questionnaires, mother interviews, and supervisor checklists.
- Assessed 173 health workers across public health facilities.
Main Results:
- Health workers frequently omitted specific ARI history and physical examinations, relying on symptomatic diagnosis.
- Inconsistent availability of essential ARI drugs and supplies was noted.
- Communication with mothers and home management instructions were often inadequate.
- Irregular supervision and limited recent continuing education for health workers were observed.
Conclusions:
- Improving pediatric ARI management necessitates a multi-faceted approach addressing policy, logistics, training, and supervision.
- In-service education and regular supervision are vital for enhancing health worker skills.
- An integrated approach to sick child management may improve overall health worker performance.
Abstract:
Health worker performance in the management of children with acute respiratory infections (ARI) was assessed in two local government areas (LGAs) in Nigeria. The data derived were utilized to identify training needs. Survey instruments included an inventory list for ARI-related equipment and supplies, observation checklists for children presenting to the health worker with ARI symptoms, a questionnaire for exist interviews with mothers, and a supervisor performance checklist. One hundred and twenty-three health workers in Ife Central LGA and 50 in Ojo were observed at selected public health facilities. Most health workers took a good general history, but specific ARI-related history and physical examination were frequently omitted. Symptomatic diagnosis and treatment were common. Drugs most commonly prescribed for treatment of ARI were chloroquine, paracetamol and antibiotics. Essential drugs and supplies for ARI management were not available in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education programme in the previous two years and supervision which could have provided on-the-spot training was irregular. Improvements in ARI case management will require attention to policy, logistics, training (including in-service education) and supervision. The possible role of an integrated approach to the management of the sick child in improving the quality of health worker performance is discussed.