Quality of sick child care delivered by Health Surveillance Assistants in Malawi.
OBJECTIVE
To assess the quality of care provided by Health Surveillance Assistants (HSAs)-a cadre of community-based health workers-as part of a national scale-up of community case management of childhood illness (CCM) in Malawi.


METHODS
Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted 'gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers.


RESULTS
HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs.


CONCLUSIONS
Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
Institute for International Programs, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore MD 21205-2103, USA. jbrycedanby@aol.com
Kate E
KE
Gilroy
Jennifer A
JA
Callaghan-Koru
Cristina V
CV
Cardemil
Humphreys
H
Nsona
Agbessi
A
Amouzou
Angella
A
Mtimuni
Bernadette
B
Daelmans
Leslie
L
Mgalula
Jennifer
J
Bryce
D000328:Adult; D019090:Case Management; D002662:Child Health Services; D002675:Child, Preschool; D003150:Community Health Workers; D005260:Female; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D036301:Qualitative Research; D011787:Quality of Health Care