Longitudinal analysis of community health workers' adherence to treatment guidelines, Siaya, Kenya, 1997-2002.
OBJECTIVE
To investigate community health workers' (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence.


METHODS
Analysis of 7151 ill-child consultations performed by 114 CHWs in their communities from March 1997-May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training.


RESULTS
The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.


CONCLUSIONS
The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.
Rowe
S Y
SY
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. say9@cdc.gov
Olewe
M A
MA
Kleinbaum
D G
DG
McGowan
J E
JE
McFarland
D A
DA
Rochat
R
R
Deming
M S
MS
D017677:Age Distribution; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards / Q000639:trends*; D006282:Health Personnel / Q000193:education; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008137:Longitudinal Studies; D015233:Models, Statistical; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards