title: Validation of community health workers' assessment of neonatal illness in rural Bangladesh.
abstract: OBJECTIVE
  To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh.
  
  
  METHODS
  CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification.
  
  
  RESULTS
  CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0.001) with 'not sucking at all' and 'not attached at all' or 'not well attached' as determined clinically by CHWs during feeding assessment.
  
  
  CONCLUSIONS
  CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. gdarmsta@jhsph.edu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Yoonjoung
authors.initials: Y
authors.lastname: Choi
authors.forename: Sanwarul
authors.initials: S
authors.lastname: Bari
authors.forename: Syed M
authors.initials: SM
authors.lastname: Rahman
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Mannan
authors.forename: A S M Nawshad Uddin
authors.initials: AS
authors.lastname: Ahmed
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Radwanur
authors.initials: R
authors.lastname: Rahman
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chang
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
mesh_terms: D000328:Adult; D001459:Bangladesh; D003150:Community Health Workers; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis; D017283:Neonatal Nursing; D015997:Neonatal Screening / Q000592:standards*; D011159:Population Surveillance; D011446:Prospective Studies; D012017:Referral and Consultation; D012424:Rural Population; D055815:Young Adult