title: Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana.
abstract: BACKGROUND
  Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines.
  
  
  METHODS
  Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral.
  
  
  RESULTS
  Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral.
  
  
  CONCLUSIONS
  CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.
authors.affiliation: Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chinbuah
authors.forename: Mercy
authors.initials: M
authors.lastname: Abbey
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
authors.forename: Philipina
authors.initials: P
authors.lastname: Ashitey
authors.forename: Jonas
authors.initials: J
authors.lastname: Akpakli
authors.forename: Shirley-Ann A
authors.initials: SA
authors.lastname: Appiatse
authors.forename: David
authors.initials: D
authors.lastname: Kubi
authors.forename: John O
authors.initials: JO
authors.lastname: Gyapong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D003150:Community Health Workers; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy; D005869:Ghana; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012424:Rural Population; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials
keywords: Children; Community health worker; Fever; Ghana; Guideline adherence; Referral