Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana
Background Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines. Methods Records...
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| Veröffentlicht in: | International health 2013-06, Vol.5 (2), p.148-156 |
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| creator | Chinbuah, Margaret A. Abbey, Mercy Kager, Piet A. Gyapong, Margaret Nonvignon, Justice Ashitey, Philipina Akpakli, Jonas Appiatse, Shirley-Ann A. Kubi, David Gyapong, John O. |
| description | Background
Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines.
Methods
Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral.
Results
Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral.
Conclusions
CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes. |
| doi_str_mv | 10.1093/inthealth/ihs008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1432620102</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/inthealth/ihs008</oup_id><sourcerecordid>1432620102</sourcerecordid><originalsourceid>FETCH-LOGICAL-c377t-edd60ced229830f095605751c2cc588e3f272c98812cf389fd5f68d1698c6c383</originalsourceid><addsrcrecordid>eNqFkU1v1DAQhiMEoh9w54TmiESX-mOTONyqFgpSpV5acYyMPd4YEnvxOKD9Zfy9ekm7V062Rs88r-W3qt5w9oGzTp77kAfUYx7O_UCMqWfVMVdts5JrVj8_3Lk8qk6IfjDWKNmIl9WRWDPJOK-Pq78XREg0YcgQHRQdaDtgwmBwPzBxmubg8w6WIPgT009MBDmCjeTDBnSwkNBhSnqEzewtjj4ggYvpn2_SQW_wKcHhb0zgA5jBj7bkwBxsmdSwQ53oI2igPNvdHrnSYTMhfEPKcOUpJ2_yGVwPRfiqeuH0SPj68Tyt7j9_urv8srq5vf56eXGzMrJt8wqtbZhBK0SnJHOsqxtWtzU3wphaKZROtMJ0SnFhnFSds7VrlOVNp0xjpJKn1bvFu03x11we0k-eDI6jDhhn6vlaikYwzkRB2YKaFInKj_Tb5Ceddj1n_b6u_lBXv9RVVt4-2ufvE9rDwlM_BXi_AHHe_l_3AJYbpfw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1432620102</pqid></control><display><type>article</type><title>Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana</title><source>MEDLINE</source><source>Access via Oxford University Press (Open Access Collection)</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Chinbuah, Margaret A. ; Abbey, Mercy ; Kager, Piet A. ; Gyapong, Margaret ; Nonvignon, Justice ; Ashitey, Philipina ; Akpakli, Jonas ; Appiatse, Shirley-Ann A. ; Kubi, David ; Gyapong, John O.</creator><creatorcontrib>Chinbuah, Margaret A. ; Abbey, Mercy ; Kager, Piet A. ; Gyapong, Margaret ; Nonvignon, Justice ; Ashitey, Philipina ; Akpakli, Jonas ; Appiatse, Shirley-Ann A. ; Kubi, David ; Gyapong, John O.</creatorcontrib><description>Background
Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines.
Methods
Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral.
Results
Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral.
Conclusions
CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.</description><identifier>ISSN: 1876-3413</identifier><identifier>EISSN: 1876-3405</identifier><identifier>DOI: 10.1093/inthealth/ihs008</identifier><identifier>PMID: 24030115</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; Antimalarials - administration & dosage ; Antimalarials - therapeutic use ; Child, Preschool ; Community Health Workers ; Drug Administration Schedule ; Female ; Fever - diagnosis ; Fever - drug therapy ; Ghana ; Guideline Adherence ; Humans ; Infant ; Logistic Models ; Malaria - diagnosis ; Malaria - drug therapy ; Male ; Middle Aged ; Multivariate Analysis ; Practice Guidelines as Topic ; Referral and Consultation ; Rural Population ; Young Adult</subject><ispartof>International health, 2013-06, Vol.5 (2), p.148-156</ispartof><rights>Royal Society of Tropical Medicine and Hygiene 2013. All rights reserved. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-edd60ced229830f095605751c2cc588e3f272c98812cf389fd5f68d1698c6c383</citedby><cites>FETCH-LOGICAL-c377t-edd60ced229830f095605751c2cc588e3f272c98812cf389fd5f68d1698c6c383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,1586,1606,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24030115$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chinbuah, Margaret A.</creatorcontrib><creatorcontrib>Abbey, Mercy</creatorcontrib><creatorcontrib>Kager, Piet A.</creatorcontrib><creatorcontrib>Gyapong, Margaret</creatorcontrib><creatorcontrib>Nonvignon, Justice</creatorcontrib><creatorcontrib>Ashitey, Philipina</creatorcontrib><creatorcontrib>Akpakli, Jonas</creatorcontrib><creatorcontrib>Appiatse, Shirley-Ann A.</creatorcontrib><creatorcontrib>Kubi, David</creatorcontrib><creatorcontrib>Gyapong, John O.</creatorcontrib><title>Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana</title><title>International health</title><addtitle>Int Health</addtitle><description>Background
Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines.
Methods
Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral.
Results
Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral.
Conclusions
CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimalarials - administration & dosage</subject><subject>Antimalarials - therapeutic use</subject><subject>Child, Preschool</subject><subject>Community Health Workers</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Fever - diagnosis</subject><subject>Fever - drug therapy</subject><subject>Ghana</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Infant</subject><subject>Logistic Models</subject><subject>Malaria - diagnosis</subject><subject>Malaria - drug therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Practice Guidelines as Topic</subject><subject>Referral and Consultation</subject><subject>Rural Population</subject><subject>Young Adult</subject><issn>1876-3413</issn><issn>1876-3405</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhiMEoh9w54TmiESX-mOTONyqFgpSpV5acYyMPd4YEnvxOKD9Zfy9ekm7V062Rs88r-W3qt5w9oGzTp77kAfUYx7O_UCMqWfVMVdts5JrVj8_3Lk8qk6IfjDWKNmIl9WRWDPJOK-Pq78XREg0YcgQHRQdaDtgwmBwPzBxmubg8w6WIPgT009MBDmCjeTDBnSwkNBhSnqEzewtjj4ggYvpn2_SQW_wKcHhb0zgA5jBj7bkwBxsmdSwQ53oI2igPNvdHrnSYTMhfEPKcOUpJ2_yGVwPRfiqeuH0SPj68Tyt7j9_urv8srq5vf56eXGzMrJt8wqtbZhBK0SnJHOsqxtWtzU3wphaKZROtMJ0SnFhnFSds7VrlOVNp0xjpJKn1bvFu03x11we0k-eDI6jDhhn6vlaikYwzkRB2YKaFInKj_Tb5Ceddj1n_b6u_lBXv9RVVt4-2ufvE9rDwlM_BXi_AHHe_l_3AJYbpfw</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Chinbuah, Margaret A.</creator><creator>Abbey, Mercy</creator><creator>Kager, Piet A.</creator><creator>Gyapong, Margaret</creator><creator>Nonvignon, Justice</creator><creator>Ashitey, Philipina</creator><creator>Akpakli, Jonas</creator><creator>Appiatse, Shirley-Ann A.</creator><creator>Kubi, David</creator><creator>Gyapong, John O.</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130601</creationdate><title>Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana</title><author>Chinbuah, Margaret A. ; Abbey, Mercy ; Kager, Piet A. ; Gyapong, Margaret ; Nonvignon, Justice ; Ashitey, Philipina ; Akpakli, Jonas ; Appiatse, Shirley-Ann A. ; Kubi, David ; Gyapong, John O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-edd60ced229830f095605751c2cc588e3f272c98812cf389fd5f68d1698c6c383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antimalarials - administration & dosage</topic><topic>Antimalarials - therapeutic use</topic><topic>Child, Preschool</topic><topic>Community Health Workers</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Fever - diagnosis</topic><topic>Fever - drug therapy</topic><topic>Ghana</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Infant</topic><topic>Logistic Models</topic><topic>Malaria - diagnosis</topic><topic>Malaria - drug therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Practice Guidelines as Topic</topic><topic>Referral and Consultation</topic><topic>Rural Population</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chinbuah, Margaret A.</creatorcontrib><creatorcontrib>Abbey, Mercy</creatorcontrib><creatorcontrib>Kager, Piet A.</creatorcontrib><creatorcontrib>Gyapong, Margaret</creatorcontrib><creatorcontrib>Nonvignon, Justice</creatorcontrib><creatorcontrib>Ashitey, Philipina</creatorcontrib><creatorcontrib>Akpakli, Jonas</creatorcontrib><creatorcontrib>Appiatse, Shirley-Ann A.</creatorcontrib><creatorcontrib>Kubi, David</creatorcontrib><creatorcontrib>Gyapong, John O.</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chinbuah, Margaret A.</au><au>Abbey, Mercy</au><au>Kager, Piet A.</au><au>Gyapong, Margaret</au><au>Nonvignon, Justice</au><au>Ashitey, Philipina</au><au>Akpakli, Jonas</au><au>Appiatse, Shirley-Ann A.</au><au>Kubi, David</au><au>Gyapong, John O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana</atitle><jtitle>International health</jtitle><addtitle>Int Health</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>5</volume><issue>2</issue><spage>148</spage><epage>156</epage><pages>148-156</pages><issn>1876-3413</issn><eissn>1876-3405</eissn><abstract>Background
Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines.
Methods
Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral.
Results
Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral.
Conclusions
CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>24030115</pmid><doi>10.1093/inthealth/ihs008</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1876-3413 |
| ispartof | International health, 2013-06, Vol.5 (2), p.148-156 |
| issn | 1876-3413 1876-3405 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1432620102 |
| source | MEDLINE; Access via Oxford University Press (Open Access Collection); Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Antimalarials - administration & dosage Antimalarials - therapeutic use Child, Preschool Community Health Workers Drug Administration Schedule Female Fever - diagnosis Fever - drug therapy Ghana Guideline Adherence Humans Infant Logistic Models Malaria - diagnosis Malaria - drug therapy Male Middle Aged Multivariate Analysis Practice Guidelines as Topic Referral and Consultation Rural Population Young Adult |
| title | Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana |
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