title: Community health workers - a resource for identification and referral of sick newborns in rural Uganda.
abstract: OBJECTIVE
  To determine community health workers' (CHWs) competence in identifying and referring sick newborns in Uganda.
  
  
  METHODS
  Case-vignettes, observations of role-plays and interviews were employed to collect data using checklists and semistructured questionnaires, from 57 trained CHWs participating in a community health facility-linked cluster randomised trial. Competence to identify and refer sick newborns was measured by knowledge of newborn danger signs, skills to identify sick newborns and effective communication to mothers. Proportions and median scores were computed for each attribute with a pre-defined pass mark of 100% for knowledge and 90% for skill and communication.
  
  
  RESULTS
  For knowledge, 68% of the CHWs attained the pass mark. The median percentage score was 100 (IQR 94 100). 74% mentioned the required five newborn danger signs unprompted. 'Red umbilicus/cord with pus' was mentioned by all CHWs (100%), but none mentioned chest in-drawing and grunting as newborn danger signs. 63% attained the pass mark for both skill and communication. The median percentage scores were 91 (IQR 82 100) for skills and 94 (IQR 89, 94) for effective communication. 98% correctly identified the four case-vignettes as sick or not sick newborn. 'Preterm birth' was the least identified danger sign from the case-vignettes, by 51% of the CHWs.
  
  
  CONCLUSIONS
  CHWs trained for a short period but effectively supervised are competent in identifying and referring sick newborns in a poor resource setting.
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda. cnalwadda@musph.ac.ug
authors.forename: Christine
authors.initials: C
authors.lastname: Kayemba Nalwadda
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.forename: Juliet
authors.initials: J
authors.lastname: Kiguli
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namazzi
authors.forename: Sarah
authors.initials: S
authors.lastname: Namutumba
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003116:Color; D003142:Communication; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000592:standards*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis*; D008297:Male; D009035:Mothers; D047928:Premature Birth; D012017:Referral and Consultation; D012424:Rural Population; D013492:Suppuration; D013909:Thorax; D014454:Uganda; D014470:Umbilical Cord; D055986:Vital Signs