title: Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda.
abstract: OBJECTIVE
  To determine the competence of community health workers (CHWs) to correctly assess, classify and treat malaria and pneumonia among under-five children after training.
  
  
  METHODS
  Consultations of 182 under-fives by 14 CHWs in Iganga district, Uganda, were observed using standardised checklists. Each CHW saw 13 febrile children. Two paediatricians observed CHWs' assessment, classification and prescription of treatment, while a laboratory scientist assessed CHW use of malaria rapid diagnostic tests (RDTs). The validity of CHWs' use of RDTs to detect malaria and respiratory timers to diagnose pneumonia was estimated using a laboratory scientist's RDT repeat reading and a paediatrician's repeat count of the respiratory rate, respectively.
  
  
  RESULTS
  From the 182 consultations, overall CHWs' performance was adequate in taking history (97%), use (following procedures prior to reading result) of timers (96%) and use of RDTs (96%), but inadequate in classification (87%). Breath readings (classified as fast or normal) were 85% in agreement with the paediatrician (κ = 0.665, P < 0.001). All RDT readings were in agreement with those obtained by the laboratory scientist. Ninety-six per cent (85/89) of children with a positive RDT were prescribed an antimalarial drug, 40% (4/10) with fast breathing (gold standard) were prescribed an antibiotic and 91% (48/53) with both were prescribed both medicines.
  
  
  CONCLUSIONS
  Community health workers can be trained to use RDTs and timers to assess and manage malaria and pneumonia in children. We recommend integration of these diagnostics into community case management of fever. CHWs require enhanced practice in counting respiratory rates and simple job aides to enable them make a classification without thinking deeply about several assessment results.
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda. dmukanga@afenet.net
authors.forename: D
authors.initials: D
authors.lastname: Mukanga
authors.forename: R
authors.initials: R
authors.lastname: Babirye
authors.forename: S
authors.initials: S
authors.lastname: Peterson
authors.forename: G W
authors.initials: GW
authors.lastname: Pariyo
authors.forename: G
authors.initials: G
authors.lastname: Ojiambo
authors.forename: J K
authors.initials: JK
authors.lastname: Tibenderana
authors.forename: P
authors.initials: P
authors.lastname: Nsubuga
authors.forename: K
authors.initials: K
authors.lastname: Kallander
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000962:Antimalarials / Q000008:administration & dosage; D019090:Case Management / Q000458:organization & administration / Q000592:standards / Q000639:trends; D002675:Child, Preschool; D060085:Coinfection; D003150:Community Health Workers / Q000193:education*; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D006801:Humans; D007223:Infant; D059232:Laboratory Personnel / Q000706:statistics & numerical data; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D012107:Research Design; D056152:Respiratory Rate; D012424:Rural Population / Q000706:statistics & numerical data / Q000639:trends; D014454:Uganda / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D000962:Antimalarials